Best practice has not been proven by evidence or agreed upon by expert consensus.3,4 It is difficult to define best practice or standards as equipment from different manufacturers are intended for use in different ways.
Based upon the available evidence, the best practice for general adult intensive care would appear to be:
- initiation of renal replacement therapy according to conventional indications and not earlier (KDIGO stage 2 or 3 for example)
- delivery of renal replacement therapy by CVVH or CVVHD for safety and efficacy
- dose of therapy, defined by the effluent production rate, of approximately 25 ml/kg/hour, as higher doses do not appear to have greater efficacy but will be more costly
- anticoagulation by citrate appears to be more efficacious and cost efficient compared with heparin.
