Preface

There is an increased incidence of chronic kidney disease (CKD) progressing to renal failure, as our aging population continues to expand across the globe. Hence, the number of people indicated for renal replacement therapy in the form of dialysis (hemodialysis and peritoneal dialysis) and renal transplantation is also increasing. National and international registry data have highlighted the growing incidence and prevalence of renal replacement therapy. Renal replacement therapy is not an appropriate option for all adults. Older patients living with advanced frailty status and a high number of comorbidities may prefer supportive care without renal replacement therapy to achieve a better quality of life in the short time they have left considering their poor overall prognosis. For those who are deemed suitable candidates for renal replacement therapy, there are many facets of care to consider in aiming for the successful delivery of renal replacement therapy – from guiding patient choice and educating patients regarding their preferred modality of renal replacement therapy to optimizing treatment adequacy and managing treatment-related complications, to ensuring there are appropriate levels of caregiver and financial support, and to integrating advances in innovation and technology in maximizing renal replacement therapy outcomes.

Renal failure may also occur as a result of acute kidney injury (AKI), which could be due to CKD and/or other causes. Renal replacement therapy in the form of continuous renal replacement therapy or other dialysis modalities may be indicated within an intensive care setting. For individuals in these circumstances, there are challenging decisions to make on whether to initiate renal replacement therapy, selection of renal replacement therapy modality, prescription and optimization of renal replacement therapy in intensive care, and at what point it may be in the patient's best interest to withdraw renal replacement therapy and consider palliative treatment.

This book provides a comprehensive global update on the delivery of renal replacement therapy, featuring extensive discussion on recent advances within various aspects of this topical area.

> **Dr. Henry H.L. Wu** Renal Research, Kolling Institute of Medical Research, The University of Sydney and Royal North Shore Hospital, Sydney, Australia

**1**

**Chapter 1**

**Abstract**

ing RRT in ICU.

**1. Introduction**

**1.1 Acute kidney injury**

broken down into three types.

Renal Replacement Therapy in

*Dhaval Patel, Hussain Majeed, Megan Joseph and Gurleen Kaur*

This chapter presents a comprehensive overview of the latest advancements in renal replacement therapy (RRT) including Continuous Renal Replacement Therapy (CRRT), focusing on key topics such as acute kidney injury (AKI), renal replacement techniques, patient selection, vascular access, dialyzer membranes, anticoagulation strategies, optimal RRT prescription, drug dosing, laboratory monitoring, and complications of RRT. The incidence of AKI in intensive care unit (ICU) is estimated to be from 5% to 50%. It carries substantial morbidity and mortality. In this chapter, we aim to emphasize the significance of AKI in ICU and indications that necessitate effective RRT. The chapter explores various renal replacement techniques with emphasis on CRRT, including continuous venovenous hemodialysis, hemodiafiltration, and hemofiltration. The clinical indications and contraindications for CRRT are discussed. Vascular access options, dialyzer membrane characteristics, and anticoagulation strategies are examined, providing insights into their impact on treatment outcomes and patient safety. Additionally, highlighted points include the importance of optimal RRT prescription, drug dosing adjustments, and laboratory monitoring in CRRT. It addresses potential complications associated with CRRT and offers strategies for their prevention and management. Overall, this book chapter aims to serve as a valuable guide for healthcare professionals, providing them with updated information to optimize patient care and improve outcomes in individuals with AKI undergo-

**Keywords:** renal failure, acute kidney injury, continuous renal replacement therapy

Acute kidney injury (AKI) is a widespread problem. It is often used interchangeably with acute renal failure. The incidence of AKI in intensive care unit (ICU) is wide ranging from 5% to 50% and specific to the type of ICU. AKI can have quite a profound impact on the patient and is associated with severe morbidity and mortality. Mortality can range from 40% to >60%. There are consensus definitions of AKI, and they are

(CRRT), hemofiltration, hemodialysis, peritoneal dialysis

Intensive Care Unit
