Optimum renal care in critically ill patients

PURPOSE OF REVIEW: To discuss the optimal renal care for critically ill patients. RECENT FINDINGS: For hemodynamic optimization, balanced crystalloids are generally preferred over normal saline, except in patients with traumatic brain injury. A restrictive fluid management strategy may be considered in patients with advanced chronic kidney disease or those on dialysis. Norepinephrine is generally the first-line vasopressor, while the roles of vasopressin and angiotensin II are under investigation. The timing of dialysis initiation should be personalized, balancing the benefits of renal support with the risks of dialytrauma. Continuous renal replacement therapy may be preferred over conventional hemodialysis in patients with hemodynamic instability or intracranial hypertension. Optimal UFNET rates range between 1.0 and 1.5 ml/kg/h. Liberation from dialysis should be actively considered in patients showing signs of renal recovery. The risk of drug-induced acute kidney injury may be mitigated through nephrotoxin stewardship. Multidisciplinary collaboration and clinical decision support systems are key approaches. Integrating novel biomarkers and artificial intelligence into patient care is a promising strategy for achieving precision medicine. SUMMARY: Optimal renal care in critically ill patients is a holistic approach that considers hemodynamics, fluid therapy, administration of vasoactive agents, kidney replacement therapy, medication stewardship, and innovative advances.