Nouveautés en épuration extra-rénale

Renal replacement therapy (RRT) is administered in 10 % of critically ill patients from the ICU. There is no difference in terms of short-term survival between the different RRT modalities (continuous/intermittent and diffusive/convective). Continuous renal replacement therapy seems to be beneficial in terms of renal recovery as compared to intermittent haemodialysis. Furthermore, CRRT should be favoured in case of hemodynamically unstable patients and/or in case of trauma brain injury. When it comes to dialysis dose, the prescribed dose must be distinguished from the administered dose. Indeed, to reach the target administered dose recommended by the international KDIGO guidelines (25 mL/kg/h), it is recommended to prescribe more (30 to 35 mL/kg/h) in order to take into account the daily multiple therapy stops (patient nursing, circuit/membrane coagulation, short transfer to the radiology department or to the operating room). Regarding timing of RRT, the current medical literature remains controversial and does not allow for robust conclusions. Citrate regional anticoagulation is nowadays the first line anticoagulation for RRT circuit in all patients, including the ones with no bleeding risk, in case of absence of citrate contra-indications. The optimal dialysis catheter is a double lumen “kidney shape” catheter, with an external diameter of 12 to 16 Fr depending on the RRT modality, with a shotgun tip and a length adapted to the insertion site.