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[Methods of continuous extracorporeal replacement of renal function]
1I. interní klinika LF UK, Plzen.
Vnitrni Lekarstvi
|December 1, 1996
Summary
Continuous renal replacement therapy methods, including continuous arteriovenous hemofiltration, are increasingly used for acute renal failure in critical patients. However, evidence for improved survival compared to intermittent dialysis is lacking, necessitating further research.
Area of Science:
- Nephrology
- Critical Care Medicine
Context:
- Continuous renal replacement therapy (CRRT) methods are increasingly utilized.
- Established CRRT techniques include continuous arteriovenous hemofiltration, continuous hemodialysis, hemodiafiltration, and high-flux dialysis.
- Veno-venous access offers an alternative to arteriovenous access.
Purpose:
- To review the current applications and indications for CRRT.
- To discuss the effectiveness and safety of CRRT in critically ill patients with acute renal failure.
- To identify areas for future research regarding CRRT efficacy and technical advancements.
Summary:
- CRRT is indicated for critically ill patients with acute renal failure, particularly those with multiorgan failure or unstable circulation, due to its perceived effectiveness and safety.
- Current evidence does not conclusively demonstrate that CRRT improves survival in acute renal failure compared to intermittent dialysis.
- The utility of CRRT in conditions like sepsis/septic shock and acute respiratory distress syndrome (ARDS) with preserved renal function remains unproven.
Impact:
- Highlights the need for well-designed studies to compare CRRT with intermittent procedures.
- Identifies key areas for future research, including technical innovations to enhance CRRT effectiveness (e.g., adsorption) and improve hemocompatibility.
- Addresses challenges related to thrombogenicity of extracorporeal circuits and anticoagulant use.