[Pharmacokinetic simulation of different modes of renal replacement therapy]

Based on the results of examination of patients with severe acute renal failure and multiorgan insufficiency, the authors give a comparative analysis of different modes of renal replacement therapy, such as intermittent hemofiltration, continuous arteriovenous hemofiltration, and continuous venovenous hemodiafiltration. Kinetic simulation in terms of urea and creatinine, by employing a one- and two-pool model for the disposition of these substances in the patient's body was taken as a basic method. The analysis led to the conclusion that continuous hemodiafiltration (CHDF) with an actually large volume of filtration and dialysis was the optimum technique for correcting uremic impairments of homeostasis in critically ill patients. CHDF failed to induce a significant metabolic stress and to noticeably affect the rate of urea and creatinine generation. Overall, all the filtration treatments are an effective means of eliminating low-molecular-weight nitrogenous metabolites that are characterized by the high rate of generation and the large volume of disposition in the organism. It is necessary only to correctly select a dose of renal therapy.