A case of acute renal failure due to septic shock successfully treated with continuous hemodiafiltration

Abstract

Renal replacement therapy (RRT) is the standard treatment for acute kidney injury (AKI); however, the ideal timing of initiation remains controversial. Here, we discuss the timing of RRT initiation based on a case in which continuous hemodiafiltration was successfully introduced in a patient with AKI associated with septic shock. An 88-year-old man with dyspnea who rushed to the emergency room was referred to our department with AKI during intensive care for septic shock. The patient was anuric with BUN 102mg/dL, Cre 4.82mg/dL, K 4.9mEq/L, and HCO3− 21.2mmol/L. RRT was started 18 h after admission and discontinued on day 4. Although the guidelines weakly recommend early initiation of RRT for septic AKI, RRT should be initiated at an appropriate time according to each institution’s system and the severity of the patient’s background.