How I provide kidney-replacement therapy – Professor Stephane Gaudry Artwork

Asia Ventilation Forum

The Asia Ventilation Forum (AVF) is a not-for-profit organisation comprising members from different Asian countries. We share our knowledge and experience in respiratory care and critical care with intensive care unit (ICU) workers across the continent with the aim of improving care and outcomes for the critically ill. There are two AVF Podcast series. "Behind-The-Scenes ICU Stories" invites colleagues to share anything and everything on their personal experiences. Expect heart-to-heart discussions on topics that may or may not have been widely described in the medical literature. "The Challenges of Airway Management During the Pandemic" invites colleagues to share anything and everything on how they deal with various clinical situations. Expect discussions on how experts personalise evidence-based medicine for the patient at the bedside. These Podcasts are hosted by Dr Jason Phua, respiratory physician and intensivist at Alexandra Hospital, National University Health System, Singapore, and Dr Jose Emmanuel Palo, intensivist at The Medical City, the Philippines.

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Asia Ventilation Forum

How I provide kidney-replacement therapy – Professor Stephane Gaudry

April 14, 2022 • Season 1 • Episode 16

In this AVF Podcast: ICU Tips & Tricks episode, Professor Stephane Gaudry discusses his evidence-based approach to kidney-replacement therapy (KRT). Professor Gaudry is a physician in the critical care department at Assistance Publique-Hopitaux de Paris and at Sorbonne Paris Nord Universite. He is the first author of the landmark Artificial Kidney Initiation in Kidney Injury (AKIKI) and AKIKI 2 studies, of a systematic review on timing of KRT published in The Lancet, and of a recent narrative review on KRT published in the New England Journal of Medicine.

Issues discussed in this interview:

What acute kidney injury is
When to start KRT
Intermittent versus continuous KRT
Intensity of KRT
When to stop KRT
Future research areas for KRT and acute kidney injury

Work cited:

1. Gaudry S, Palevsky PM, Dreyfuss D. Extracorporeal kidney-replacement therapy for acute kidney injury. N Engl J Med 2022;386:964-75.

2. Gaudry S, Hajage D, Benichou N, et al. Delayed versus early initiation of renal replacement therapy for severe acute kidney injury: a systematic review and individual patient data meta-analysis of randomised clinical trials. Lancet 2020;395:1506-15.

3. Gaudry S, Hajage D, Schortgen F, et al. Initiation strategies for renal-replacement therapy in the intensive care unit. N Engl J Med 2016;375:122-33.

4. Barbar SD, Clere-Jehl R, Bourredjem A, et al. Timing of renal-replacement therapy in patients with acute kidney injury and sepsis. N Engl J Med 2018;379:1431-42.

5. Starrt-Aki Investigators, Canadian Critical Care Trials Group, Australian New Zealand Intensive Care Society Clinical Trials Group, et al. Timing of initiation of renal-replacement therapy in acute kidney injury. N Engl J Med 2020;383:240-51.

6. Gaudry S, Hajage D, Martin-Lefevre L, et al. Comparison of two delayed strategies for renal replacement therapy initiation for severe acute kidney injury (AKIKI 2): a multicentre, open-label, randomised, controlled trial. Lancet 2021;397:1293-300.

7. Vinsonneau C, Camus C, Combes A, et al. Continuous venovenous haemodiafiltration versus intermittent haemodialysis for acute renal failure in patients with multiple-organ dysfunction syndrome: a multicentre randomised trial. Lancet 2006;368:379-85.

8. Rabindranath K, Adams J, Macleod AM, Muirhead N. Intermittent versus continuous renal replacement therapy for acute renal failure in adults. Cochrane Database Syst Rev 2007:CD003773.

9. Mehta RL, McDonald B, Gabbai FB, et al. A randomized clinical trial of continuous versus intermittent dialysis for acute renal failure. Kidney Int 2001;60:1154-63.

10. Schortgen F, Soubrier N, Delclaux C, et al. Hemodynamic tolerance of intermittent hemodialysis in critically ill patients: usefulness of practice guidelines. Am J Respir Crit Care Med 2000;162:197-202.

11. VA NIH Acute Renal Failure Trial Network, Palevsky PM, Zhang JH, et al. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med 2008;359:7-20.

12. Renal Replacement Therapy Study Investigators, Bellomo R, Cass A, et al. Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med 2009;361:1627-38

13. Gaudry S, Grolleau F, Barbar S, et al. Continuous renal replacement therapy versus intermittent hemodialysis as first modality for renal replacement therapy in severe acute kidney injury: a secondary analysis of AKIKI and IDEAL-ICU studies. Crit Care 2022;26:93

14. Poyan Mehr A, Tran MT, Ralto KM, et al. De novo NAD(+) biosynthetic impairment in acute kidney injury in humans. Nat Med 2018;24:1351-9