The role of hemofiltration in the critically-ill intensive care unit patient: present and future

The development of acute renal failure (ARF) in intensive care unit (ICU) patients carries a poor prognosis. Today, most cases are no longer an isolated organ dysfunction but are part of a multiple system organ failure syndrome. Recently developed renal replacement therapies allow adequate metabolic control, even in highly catabolic and hemodynamically unstable patients. Whether these newer continuous techniques have resulted in a better outcome of these patients is unclear. Recent data suggest a possible beneficial effect of hemofiltration on outcome of ICU patients and the course of human and experimental septic shock, which may be ascribed to the removal of inflammatory mediators. The purpose of this paper is to review the history of hemofiltration techniques and to assess their present and future role in the management of ICU patients. Although hemofiltration has been shown to improve hemodynamics of experimental septic shock, convincing evidence that hemofiltration improves outcome of ICU patients is lacking. Available data suggest that high ultrafiltrate volumes may be needed to achieve clinically important beneficial effects of hemofiltration in these patients. Prospective, randomized trials in homogeneous patient groups are needed to assess the role of hemofiltration in patients with septic shock or multiple system organ failure.