Efficacy of different renal replacement therapies in intensive care unit patients. A systematic review

Abstract

Introduction: Renal replacement therapies are procedures that can be performed in the intensive care unit (ICU) and are an essential tool for the management of kidney disease, therefore, it is important to know the various techniques that exist and that can be applied in critical patients.

Objectives: to establish the efficacy of different renal replacement therapies in patients admitted to intensive care units.

Materials and Methods: A systematic review was developed with the PRISMA 2020 statement, on the research question What is the effectiveness of renal replacement therapies in intensive care unit? in databases such as Pubmed, Google Scholar, ScienceDirect, Mendely, Wiley Online Library, IntechOpen, with search patterns: renal replacement therapies in intensive care unit, hemodialysis, hemodiafiltration, hemoperfusion and combined therapies in acute renal injury, for data analysis and to develop the research question from scientific publications of the last 5 years.

Results On the timing of initiation of renal replacement therapy in continuous acute renal failure under discussion, since accelerated onset compared to standard onset has not been shown to be beneficial.  Continuous renal replacement therapy and intermittent haemodialysis were the most commonly performed strategies in the intensive care unit in the setting of acute kidney injury. The results on mortality in hemodialysis comparing two techniques: 54.4 % in the CRRT group and 46.5 % in the IHD group, obtained worse results in ischemic heart disease for continuous replacement.

Conclusions: Renal replacement in the intensive care setting is a current and developing issue with wide variability in efficacy and superiority between one specific therapy over another, in the elimination of uremic toxins and this depends more on the clinical situation of the patient. For example, in a patient with phosphorus organ poisoning, carbamates, paraquat, heme perfusion should be considered first-line, always supported by hemodialysis. In cases of rhabdomyolysis, intermittent hemodialysis obtained superior results to other therapies. In patients with kidney disease, hemodiafiltrations has been shown to have a lower risk of mortality compared to conventional hemodialysis. For this reason, it is concluded that all the techniques investigated demonstrated their specific usefulness in the intensive care unit.