Acute kidney injury has been defined by the Kidney Disease: Improving Global Outcomes group.1 Conventional indications of emergency renal replacement therapy include hyperkalaemia, hyperuraemia, acidaemia, fluid overload and for the removal of small and water soluble toxins.2 The need for renal replacement therapy in critically ill patients occurs in up to 60% of intensive care admissions and is associated with a mortality rate of 15-60%.3
Most commonly, renal replacement therapy is delivered in critical care units by continuous venovenous therapies and can be subdivided according to the modality of solute clearance: convective haemofiltration (CVVH), osmotic dialysis (CVVHD) or a combination of these (CVVHDF).
Intermittent vascular and peritoneal renal replacement therapies are usually administered to stable patients by dedicated renal therapy services and are not covered in this quality improvement project.
Various clinical trials have attempted to provide empirical evidence to guide clinical care with regards to timing of initiation, mode of delivery, dose of therapy, types of extracorporeal circuits and filters and anticoagulation method.
