Increase of continuous treatments and regional citrate anticoagulation during renal replacement therapy in the ICUs of the North-West of Italy from 2007 to 2015.

Background: Few reports have addressed the change in renal replacement therapy (RRT) management in the Intensive care Units (ICUs) over the years in western countries. This study aims to assess the trend of dialytic practice in a 4.5-million population-based study of the northwest of Italy.

[Differential diagnosis of acute kidney injury in critically ill patients: the nephrologist's role in identifying the different causes of parenchymal damage].

The management of acute kidney injury in the critical area is complex and necessarily multidisciplinary, but the nephrologist should maintain a pivotal role, both in terms of diagnosis and of indication, prescription and management of extracorporeal replacement therapy. The most frequent causes of AKI in the critically ill patients are correlated to sepsis and major surgery, but the incidence of different causes, of strict nephrological relevance, is probably higher than the estimate. Nephrologists have the competence to evaluate data relating to renal functions, urinary electrolytes, urinary sediment, and to identify which specific examinations can be useful to define the cause of AKI.

[The management of antibiotic therapy in critically ill patients with AKI: between underdosing and toxicity].

Changes in microbiology and dialysis techniques in intensive care have made the use of antibiotics on nephropathic patients more complex. Several recent studies have modified our knowledge about the use of antibiotics in the care of critically ill patients, highlighting the frequency of their inappropriate use: both underdosing, risking low efficacy, and overdosing, with an increase in toxicity. Kidneys, organs devoted to excretion and metabolism, are a potential target of pharmacological toxicity.

Regional citrate anticoagulation for renal replacement therapies in patients with acute kidney injury: a position statement of the Work Group "Renal Replacement Therapies in Critically Ill Patients" of the Italian Society of Nephrology.

Patients with acute kidney injury (AKI) on renal replacement therapy (RRT) are at increased risk for bleeding but usually require anticoagulation of the extracorporeal circuit, a key prerequisite for delivery of an adequate RRT dose. To this end, many anti-hemostatic strategies have been proposed, unfractionated heparin--with all of its significant drawbacks and complications--being the most common method used so far. In this clinical context, regional citrate anticoagulation (RCA) could represent the most promising strategy, and it has been endorsed by recent guidelines on AKI.

Renal replacement therapy in intensive care units: a survey of nephrological practice in northwest Italy.

Background: Few reports have addressed how current practice reflects uncertainty as to the optimal management of renal replacement therapy (RRT) in Western countries. Current dialytic practice for 2007 in the northwest of Italy was assessed.

Methods: A total of 24 nephrology and dialysis centers covering all of the RRT provided in the intensive care units (ICUs) in northwest Italy took part in the survey.

Acute renal failure in critically ill patients: indications for and choice of extracorporeal treatment.

The prescription of extracorporeal therapy for patients with acute renal failure involves many options: dialysis sessions may be intermittent or continuous, semicontinuous or slow-extended, with controversial indications still to be defined also depending on technical and logistic issues and related to the multidisciplinary cooperation needed in the management of critically ill patients. All efforts to evaluate extracorporeal treatments in these patients must be targeted not only towards supporting renal function, but towards all functional and metabolic derangements that can result from artificial blood purification, in any way achievable.