Proceedings of the University of Alabama at Birmingham Continuous Renal Replacement Therapy Academy (2023–2024)

In this second installment of the proceedings of the University of Alabama at Birmingham Continuous Renal Replacement Therapy (CRRT) Academy, we focus on the topic of transitions of care in acute renal replacement therapy (RRT). Although we have accumulated data from thousands of critically ill patients with AKI randomized to different strategies for RRT initiation, no trial data exist to guide de-escalation of RRT in the intensive care unit. However, for survivors of severe AKI whose kidney function does not recovery rapidly enough to allow for liberation directly from CRRT, successful de-escalation of care requires the transition from CRRT to intermittent RRT modalities. These transition periods must be carefully navigated since they can be a source of complications, such as failure to transition or intradialytic hypotension, which are in turn associated with an increased risk of mortality and reduced odds of kidney recovery. In this review, we focus on the critical factors to consider during de-escalation of RRT care, with a focus on modality transition, the role of volume status in guiding the approach to de-escalation of RRT, and the vital importance of careful dosing of drugs, especially antimicrobial agents, during this transitional period.

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Publication Details

Journal
Kidney360
Published
2025-08-08
DOI
https://doi.org/10.34067/kid.0000000951
Citations
1
Primary Topic
Acute Kidney Injury Research
Type
article
Field-Weighted Citation Impact
1.43
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article

Proceedings of the University of Alabama at Birmingham Continuous Renal Replacement Therapy Academy (2023–2024)

Javier A. Neyra, Samuel A. Silver, Lilia Rizo‐Topete, Pranav Sandilya Garimella et al.
1 citations
Kidney360
Acute Kidney Injury Research
1.43
article

Proceedings of the University of Alabama at Birmingham Continuous Renal Replacement Therapy Academy (2023–2024)

Javier A. Neyra, Samuel A. Silver, Lilia Rizo‐Topete, Pranav Sandilya Garimella, William Beaubien–Souligny, Melissa L. Thompson Bastin, Keith Wille, Luis A. Juncos, Jorge Cerdá, Rajesh Speer, Ashita Tolwani, Amanda Dijanic Zeidman, Ravindra L. Mehta, Lenar Yessayan, Catherine Wells, J. Pedro Teixeira, Michael Connor, Arnaldo Lopez‐Ruiz, Thiago Reis, J. Ricardo Da Silva, Anitha Vijayan
article en
1 citations

Abstract

In this second installment of the proceedings of the University of Alabama at Birmingham Continuous Renal Replacement Therapy (CRRT) Academy, we focus on the topic of transitions of care in acute renal replacement therapy (RRT). Although we have accumulated data from thousands of critically ill patients with AKI randomized to different strategies for RRT initiation, no trial data exist to guide de-escalation of RRT in the intensive care unit. However, for survivors of severe AKI whose kidney function does not recovery rapidly enough to allow for liberation directly from CRRT, successful de-escalation of care requires the transition from CRRT to intermittent RRT modalities. These transition periods must be carefully navigated since they can be a source of complications, such as failure to transition or intradialytic hypotension, which are in turn associated with an increased risk of mortality and reduced odds of kidney recovery. In this review, we focus on the critical factors to consider during de-escalation of RRT care, with a focus on modality transition, the role of volume status in guiding the approach to de-escalation of RRT, and the vital importance of careful dosing of drugs, especially antimicrobial agents, during this transitional period.

Kidney360Vol. 6(10)
Intermountain Healthcare (US), University of Kentucky (US), Emory University (US), University of New Mexico (US), Universidade de São Paulo (BR), Queen's University (CA), University of Michigan (US), AdventHealth Orlando (US), University of Mississippi Medical Center (US), University of Alabama at Birmingham (US), University of California San Diego (US), Central Arkansas Veterans Healthcare System (US), Mount Sinai Hospital (US), Mount Sinai Hospital (US), Deerfield (United States) (US), Pulmonary and Allergy Associates (US), Hospital Universitario Dr José Eleuterio Gonzalez (MX), Centre Hospitalier de l’Université de Montréal (CA), Albany Medical Center Hospital (US), Baxter (United States) (US)
Good health and well-being
Openalex Percentile: Top 17%
Acute Kidney Injury Research
1.43
DOIOpen Access PDFOpenAlex
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