[Hemodialysis and hemosorption in acute kidney failure]

The impact of various techniques of extrarenal blood clearance, such as successive ultrafiltration, hemodialysis, hemodiafiltration (1221 procedures) and 384 sessions of hemosorption, on the levels of depuration of low- and medium-sized molecular metabolites were studied in 331 patients with acute renal failure (ARF). The routine of filtration was based on clinical and biochemical parameters and the status of the water balance. The most efficient technique turned to be a combination of hemodialysis and hemosorption defined with regard to the etiological factor, pathogenetic features and the level of nephropathy. In line with a significant decrease in urea and creatinine levels and normalization of electrolytes and acid-base balance, the author marked that the levels of medium-sized molecular peptides were 43.17-45.30 per cent lower. The administration of pharmacological agents for the improvement of hemodynamics, blood rheologic properties and microcirculation contributed to the isolation of metabolites form the tissue depot and the better depuration by the technique of extrarenal purification. A comparative study of the efficacy of the complex intensive care for ARF patients between 1982 and 1984 and between 1985 and 1987 is indicative to a significant decrease in the total fatality of those whose ARF developed due to the syndrome of positional compression (from 36.36 to 3.85 per cent), acute glomerulonephritis (from 36.26 to 15.63 per cent) and acute poisoning (from 32.61 to 19.30 per cent).