Will you implement the conservative dialysis strategy from the LIBERATE-D trial for patients with dialysis-requiring acute kidney injury, or will you continue dialysis on a schedule until recovery based on creatinine and urine output?
In the LIBERATE-D trial, patients in the conservative dialysis group underwent dialysis only when meeting criteria such as serum urea nitrogen >112 mg/dL, hyperkalemia with potassium >6 mmol/L or more than 5.5 mmol/L despite medical treatment, metabolic acidosis with pH <7.15, severe pulmonary edema causing significant hypoxemia, or clinician judgment.
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How will you perform dialysis in patients with dialysis-requiring acute kidney injury in light of the LIBERATE-D trial results?
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2 Answers
Mednet MemberInvited Expert
Nephrology · University Of California San Francisco Medical Center At Parnassus
Answered on
I think I have always dialyzed patients with AKI on an as-needed basis. The question is whether to follow the parameters set by the LIBERATE-D study (bun >112, etc.). I am not yet sure what my practice will look like in the future as far as the parameters. It is likely the case, though, that I would...
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Mednet MemberInvited Expert
Nephrology · University Of California San Francisco Medical Center At Parnassus
Answered on
The real problem is fluid. Patients with ATN are often oliguric, and we all know that ICU patients are almost always fluid overloaded. Even with 3 days per week dialysis, it is hard to keep fluid balance even in an ICU patient who may still be hypotensive. In the LIBERATE-D trial, the intervention a...
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