How do you decide UF volume and rate in ARF?
My concern is that we have to remove adequate UF in oligouric or anuric patients so that they don’t develop fluid overload, but at the same time if we remove excess UF voulme patients might have further pre renal type of ischemic injuries to kidneys leading to delayed recovery from AKI ( after all Hemodialysis itself to some extent is nephrotoxic !)
So how do you adjust the balance ?
My second question is how frequently ( daily or alternate day or only when required ) you prescribe hemodialysis in ARF patients ? And how long to continue dialysis in such patients ?
Dear Shailendra
This is such a wide question - the causes (and effects) of acute renal injury are just so extensive that there can be no ‘rule of thumb’ regarding volume status - - almost every patient is different, as are their volume circumstances. I must say that I prefer background continuous renal replacement therapy (CRRT) over intermittent HD in the management of AKI and if this is available to you, it always provides smoother, less disruptive ‘up/down’ volume control. That said, the volume status of each patient must be judged on its merits by all the levers you have to measure and control it, especially pre- and post-load measures of venous and arterial pressure. HD is fine for maintenance CKD management, but in my view, CRRT in any one of its’ multiple variations is a better option in AKI.