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<p>The indications to initiate acute renal replacement therapy (ARRT) include treatment refractory disturbances of the electrolyte, acid-base or fluid status as well as severe clinical symptoms of the uremic syndrome. In most other cases a&#xa0;watch and wait strategy is justified, provided that a clinical re-evaluation is performed at least daily; however, if the clinical situation and trajectory of the disease suggest that ARRT will be necessary, treatment should be initiated even in the absence of urgent indications. Continuous and intermittent modalities should be used as complementary procedures. For anticoagulation a&#xa0;regional citrate or systemic heparin (mostly with unfractionated heparin) can be used in most cases. Guidelines recommend a&#xa0;total effluent volume (dialysate plus filtrate) of 20–25 ml/kg/h for continuous ARRT, which will usually require a&#xa0;higher prescription of effluent volume. Weaning from ARRT can be attempted in patients with stable hemodynamics, fluid, electrolyte and acid-base status who have regained a relevant urine output (&gt; 300–600 ml/24 h).</p>

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S3-Leitlinie Nierenersatztherapie in der Intensivmedizin

  • 期刊论文

  • 发表日期：

    2025年10月20日

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  • Ana Harth,
  • Carsten Willam,
  • Achim Jörres

摘要

The indications to initiate acute renal replacement therapy (ARRT) include treatment refractory disturbances of the electrolyte, acid-base or fluid status as well as severe clinical symptoms of the uremic syndrome. In most other cases a watch and wait strategy is justified, provided that a clinical re-evaluation is performed at least daily; however, if the clinical situation and trajectory of the disease suggest that ARRT will be necessary, treatment should be initiated even in the absence of urgent indications. Continuous and intermittent modalities should be used as complementary procedures. For anticoagulation a regional citrate or systemic heparin (mostly with unfractionated heparin) can be used in most cases. Guidelines recommend a total effluent volume (dialysate plus filtrate) of 20–25 ml/kg/h for continuous ARRT, which will usually require a higher prescription of effluent volume. Weaning from ARRT can be attempted in patients with stable hemodynamics, fluid, electrolyte and acid-base status who have regained a relevant urine output (> 300–600 ml/24 h).