Blood purification and acute renal failure: the timing, method selection and dosing of renal replacement therapy

Czech version

Authors: T. Kotulák
Authors‘ workplace: Klinika anesteziologie, resuscitace a intenzivní medicíny VFN a 1. LF UK v Praze
Published in: Anest. intenziv. Med., 19, 2008, č. 1, s. 26-31
Category: Intensive Medicine

Overview

Acute renal injury (ARI) is a frequent complication in critically ill patients. Despite the development of new renal replacement techniques (RRT), better nutritional support and haemodynamic monitoring over past decades the mortality of ARI remains high (60%). There are several issues in the management of RRT. The first question is the timing of the initiation of the intervention and its impact on the outcome of ARI and renal recovery. Results of trials on early versus late initiation of renal replacement therapy do not allow the drawing of definitive conclusions. Survival or recovery of renal function has been evaluated as an outcome in several trials comparing continuous RRT (CRRT) to intermittent haemodialysis (IHD) in critically ill patients. Despite better haemodynamic stability in the CRRT groups, the studies did not detect any difference in survival or renal recovery between the groups. One study demonstrated increased survival of ARI patients treated with daily IHD versus alternate day IHD. New hybrid therapies such as slow low-efficient daily dialysis (SLEDD) show promising features due to combining the advantages of CRRT and IHD. The concept of mediator removal using high volume haemofiltration (HVHF) has been discussed as an experimental therapy in sepsis. A large multicentric randomized clinical trial shall provide more answers. At this time HVHF cannot be routinely considered as adjunctive therapy of sepsis without ARI. In conclusion, according to the current knowledge the outcome of ARI is not influenced by the modality of RRT used.

Keywords:
acute renal injury – continuous renal replacement therapy – haemodialysis – haemofiltration – renal replacement therapy – slow low-efficient daily dialysis – dose

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