Intensive care for CKD patients

: In Japan, the number of patients with chronic kidney disease (CKD) has increased. Hence, the opportunities for intensive care management of patients with CKD have also increased. Acute kidney injury (AKI) easily develops following CKD, and conversely, it can be a risk factor for CKD. At the time when CKD patients require ICU admission, their disease is already very severe, and the mortality rate tends to be high due to a number of associated complications. During the hemodynamic management of these patients, not only static indices such as CVP, but also dynamic indices such as stroke volume variation (SVV) should be used, since their circulation is very precariously balanced. While "goal-directed" hemodynamic management, which targets particular hemodynamic variables, might be useful in CKD patients, there is no evidence to prove its efficacy. Renal Replacement Therapy (RRT) is usually started after metabolic acidosis, hyperkalemia, ingestion of dialyzable toxin, volume overload and uremia have occurred. However, it is not clear whether continuous or intermittent RRT is beneficial in these patients.