Episode 63: Understanding dialysis, with Paul Adams

In this episode of Critical Care Scenarios, Brandon Odo and Brian Bowling host Dr. Paul Adams, a nephrologist, to discuss renal replacement therapy in the ICU. The episode revolves around a case of a 72-year-old male with diabetes, hypertension, and stage three chronic kidney disease who develops pneumonia and sepsis, leading to worsening kidney function and the need for dialysis. Dr. Adams explains the nuances of deciding when to initiate dialysis, the importance of volume management, and the different modalities of continuous renal replacement therapy (CRRT) versus intermittent hemodialysis. The discussion covers practical aspects such as effluent rates, anticoagulation, troubleshooting common issues like high pressures and circuit clotting, and monitoring patients on CRRT, as well as when to transition patients from CRRT to intermittent dialysis, and the role of a furosemide stress test.