[Acute renal replacement therapy in the intensive care unit]

On the intensive care department the most frequently used acute renal replacement techniques are intermittent haemodialysis and continuous haemofiltration. Although continuous techniques appear to have distinct advantages in the treatment of critically ill patients, no consistent differences in mortality have been found between continuous and intermittent treatment modalities. Due to uncertainty in this area, the use of unmodified cellulose membranes is probably best avoided. No good randomised studies are available with regard to the starting time of renal replacement techniques in critically ill patients. However, generally speaking a 'late' start should be avoided. With continuous techniques, the filtration volume should not be below 35 ml/kg/h. Although continuous (high-volume) filtration techniques may contribute to an improvement in the haemodynamics, the mechanisms behind this phenomenon remain unclear. At present, no randomised studies are available which have shown a beneficial effect of continuous techniques on the survival of critically ill patients without manifest renal insufficiency being demonstrated.