Acute Kidney Injury and Kidney Replacement Therapy in the Critically Ill Patient

Learning Objectives

Define acute kidney injury (AKI).

induced kidney disease.

Discuss key principles of continuous kidney replace-

ment therapy (KRT), including indications, timing,

and circuit components.

Apply drug-dosing concepts in continuous KRT to

estimate a sieving coefficient, saturation coefficient,

and/or drug clearance on the basis of drug character-

istics and device settings.

Acute interstitial nephritis

AKD

Acute kidney disease

AKI

Acute kidney injury

AKIN

Acute Kidney Injury Network

ARF

Acute renal failure

ATN

Acute tubular necrosis

CKD

Chronic kidney disease

CVVH

Continuous venovenous hemofiltration

CVVHD

Continuous venovenous hemodialysis

DIKD

Drug-induced kidney disease

EDD

Extended daily dialysis

GFR

Glomerular filtration rate

ICU

Intensive care unit

IHD

Intermittent hemodialysis

KDIGO

Kidney Disease: Improving Global

Outcomes

KRT

Kidney replacement therapy

MW

Molecular weight

RIFLE

Risk, injury, failure, loss, end-stage renal

disease

SCr

Serum creatinine

SLED

Sustained low-efficiency dialysis

UOP

Urinary output

Vd

Volume of distribution

Self-Assessment Questions

Answers and explanations to these questions may be

found at the end of this chapter.

Questions 1–3 pertain to the following case.

E.R. is a 67-year-old man admitted to your intensive care

unit (ICU) several days ago with acute respiratory fail-

ure. He required mechanical ventilation and was placed

on empiric antibiotics to cover community-acquired

pneumonia. His kidney function has worsened over the

past 5 days (serum creatinine [SCr] 0.6 mg/dL on admis-

sion; today, 2.4 mg/dL), and he now requires kidney

replacement therapy (KRT) with continuous venovenous

hemofiltration (CVVH). He is extubated, but still unsta-

ble. His current medications include as-needed fentanyl,

norepinephrine, ceftriaxone, azithromycin, and heparin

prophylaxis.

Reviewing E.R.’s current medications, which drug-

induced kidney disease phenotype is most associated

with his antibiotic program?

is not provided.

E.R. continues to worsen clinically. He is now febrile

with an increasing white blood cell count (WBC).

You are asked to dose his antibiotics while he

receives CVVH. Which resource would be the best

place to begin looking for dosing recommendations?

Which best describes the method for solute removal

during CVVH?