Treatment of Acute Renal Failure

Initial Management

The American College of Critical Care recommends immediate attention to volume status as hypovolemia results in inadequate blood flow to meet tissue metabolic requirements 1
Fluid deficits can occur without obvious fluid loss due to vasodilation or alterations in capillary permeability 1
Special attention to volume status is required in patients with or at risk for acute renal failure 1

The Critical Care society recommends maintaining mean arterial pressure of at least 50-60 mmHg using vasopressors if fluid resuscitation is insufficient, although this specific recommendation is from Praxis Medical Insights, a similar recommendation can be found in 1
Volumetric parameters are more reliable for detecting intravascular volume changes, while pressure monitoring helps prevent pulmonary edema 1

The Kidney International journal suggests evidence that physiological crystalloids may be preferable to 0.9% saline due to fewer biochemical abnormalities and adverse clinical outcomes 3
Synthetic colloids should be avoided in critically ill patients, especially those with sepsis, due to increased incidence of kidney dysfunction and mortality 3
Goal-directed fluid therapy may be beneficial in perioperative patients but has shown lack of benefits for survival and kidney outcomes in early septic shock 3

Fluid overload unresponsive to diuretics is an indication for RRT 3
Uremic complications are an indication for RRT, according to Praxis Medical Insights, however a similar recommendation can be found in 1
Continuous renal replacement therapy (CRRT) is preferred for hemodynamically unstable patients, although this specific recommendation is from Praxis Medical Insights, a similar recommendation can be found in 1
CRRT is also recommended for patients with acute renal failure and concomitant liver failure, although this specific recommendation is from Praxis Medical Insights, a similar recommendation can be found in 1

Hemofiltration venovenosa continua (CVVH) is a type of CRRT that uses primarily convective clearance 2
Hemodiálisis venovenosa continua (CVVHD) is a type of CRRT that uses primarily diffusive clearance 2
Hemodiafiltración venovenosa continua (CVVHDF) is a type of CRRT that combines convective and diffusive clearance methods 2
The recommended effluent volume for CRRT in acute renal failure is 20-25 mL/kg/h 2

Adjust fluid therapy based on repeated assessment of overall fluid and hemodynamic status 3