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Published on: July 19, 2018
[Renal replacement therapy in the intensive care unit. Current aspects].
T M Bingold1, B Scheller, B Zwissler
1Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Klinikum der Johann Wolfgang Goethe-Universität, Theodor-Stern-Kai 7, 60590 Frankfurt a.M. Bingold@em.uni-frankfurt.de
Der Anaesthesist
|October 27, 2007
Summary
Acute renal failure (ARF) management in intensive care is challenging. Continuous renal replacement therapy (CRRT) is standard, but its superiority over intermittent hemodialysis (IHD) in reducing mortality is unproven, pending further studies.
Area of Science:
- Nephrology
- Intensive Care Medicine
- Renal Replacement Therapy
Context:
- Acute renal failure (ARF) is a frequent and serious complication in intensive care units (ICUs).
- Despite advances, ARF incidence is rising, with persistently high mortality rates.
- Continuous renal replacement therapy (CRRT) is the established treatment for ARF in Europe.
Purpose:
- To review the current landscape of renal replacement therapy for ARF.
- To compare the efficacy and outcomes of CRRT versus intermittent hemodialysis (IHD).
- To discuss emerging techniques like slow extended daily dialysis (SLEDD).
Summary:
- CRRT offers advantages in hemodynamic stability and fluid management over IHD for ARF patients.
- Current evidence does not definitively establish CRRT's superiority over IHD in reducing ARF mortality.
- Recommended CRRT dosing is 35 ml/kg/h; SLEDD presents a promising hybrid approach requiring further investigation.
Impact:
- Highlights the need for evidence-based guidelines for ARF treatment optimization.
- Identifies critical ongoing multicenter trials (ATN study, ANZICS 2005) that will shape future ARF management.
- Emphasizes the importance of comparative effectiveness research in critical care nephrology.
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