Precision net ultrafiltration dosing in continuous kidney replacement therapy: a practical approach
Raghavan Murugan, Kianoush Kashani, Paul M. Palevsky
Abstract
Fluid overload occurs in more than two-thirds of critically ill patients with acute kidney injury (AKI) receiving kidney replacement therapy (KRT) and is independently associated with morbidity and mortality [ 1 , 2 ]. International consensus guidelines recommend extracorporeal net fluid removal when a life-threatening fluid overload occurs in a patient with oliguric AKI refractory to diuretics [ 3 , 4 , 5 ]. However, the optimal method of net fluid removal during KRT remains to be determined, and there is global variation in clinical practice [ 6 , 7 , 8 , 9 , 10 ]. Some clinicians propose using net fluid balance as a target for the fluid removal [ 11 , 12 ], while others suggest using the prescribed vs. delivered net fluid removal gap [ 13 , 14 ]. However, all these methods influence the net fluid removal rate ( i.e., net ultrafiltration rate [UF NET ] rate) one way or another during KRT.