REVIEW  DIAGNOSIS AND TREATMENT OF ACUTE KIDNEY INJURY Free access

Minerva Urologica e Nefrologica 2016 February;68(1):87-104

Copyright © 2016 EDIZIONI MINERVA MEDICA

lingua: Inglese

Anticoagulation for renal replacement therapy for patients with acute kidney injury

Arkom NONGNUCH ¹, Viratch TANGSUJARITVIJIT ², Andrew DAVENPORT ³ ✉

¹ Renal Unit, Department of Medicine Faculty of Medicine, Ramathibodi Hospital Mahidol University, Bangkok, Thailand; ² Pulmonary and Critical Care Unit Department of Medicine Faculty of Medicine, Ramathibodi Hospital Mahidol University, Bangkok, Thailand; ³ UCL Centre for Nephrology, Royal Free Hospital University College London Medical School, London, UK

Patients with acute kidney injury are generally prothrombotic, and as such prone to increased risk of clotting in extracorporeal renal replacement therapy (RRT) circuits. Although some patients may be adequately treated by intermittent RRT, however due to cardiovascular instability many patients are treated by continuous renal replacement therapy (CCRT) or prolonged intermittent renal replacement therapy (PIRRT). Clotting in the RRT circuit not only reduces the efficiency of solute clearances, affects fluid balance, but also has economic health care costs. The longer duration RRT modes, CRRT and PIRRT are more prone to clotting, and more dependent on adequate anticoagulation. This review will compare the currently available systemic and regional anticoagulation options for CRRT and PIRRT for the patient with acute kidney injury.