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ICU AKI requiring RRT — ESENeph MCQ

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HardAcute Kidney Injury, Electrolytes and Acid-BaseICU AKI requiring RRTESENeph

A 62-year-old man in ICU has septic shock, pulmonary oedema and AKI. He is receiving noradrenaline and high-flow oxygen; potassium is 6.0 mmol/L after temporising therapy. pH is 7.18, bicarbonate 13 mmol/L and urine output is 80 mL in 12 hours. What is the most appropriate renal replacement modality?

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Correct answer: E — Continuous veno-venous haemodiafiltration

In haemodynamically unstable ICU patients with refractory hyperkalaemia, acidosis and fluid overload, continuous renal replacement therapy is generally preferred for better haemodynamic tolerance. Creatinine alone is not the trigger for dialysis; complications and clinical context drive the decision. Home peritoneal dialysis and transplant assessment are chronic pathways rather than emergency ICU modalities. The pearl is that urgent RRT indications remain refractory potassium, acidosis, pulmonary oedema, uraemic complications and certain toxins.

Reference: https://guidelines.ukkidney.org