Renal Replacement Therapy Capability for the Treatment of Combat-Associated Acute Kidney Injury: A Historical Perspective to Plan for Future Conflicts

Trauma-induced acute kidney injury (AKI) has affected many U.S. warfighters throughout history. We seek to provide a historical review of the epidemiology of combat-acquired AKI and to highlight the importance of adapting current renal replacement therapy (RRT) capabilities to prepare for the next armed conflict. While severe AKI was rare in the recent conflicts in Iraq and Afghanistan, an analysis of prior wars suggests that it will be more common in future combat operations characterized by prolonged evacuation times, limited resuscitation capabilities, and delayed aeromedical evacuation. Therefore, the military community must develop RRT capabilities to satisfy the demands of prolonged field care and austere environments. We propose a series of solutions such as re-enforcing forward deployment of conventional RRT capabilities as well as novel therapies such as improvised dialysis systems or sorbent-based RRT.