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A primer on continuous renal replacement therapy for critically ill patients
M S Joy1, G R Matzke, D K Armstrong
1Division of Nephrology and Hypertension, School of Medicine, University of North Carolina, Chapel Hill, USA.
The Annals of Pharmacotherapy
|April 9, 1998
Summary
Continuous renal replacement therapy (CRRT) is used for critically ill adults, but its impact on patient outcomes and drug dosing requires careful individualization. Further research is needed to confirm survival benefits compared to conventional hemodialysis.
Area of Science:
- Critical Care Medicine
- Nephrology
- Clinical Pharmacology
Background:
- Continuous renal replacement therapy (CRRT) is a vital treatment for hemodynamically unstable critically ill adults.
- CRRT indications have expanded beyond acute renal failure to include conditions like septic shock and hepatic failure.
Purpose of the Study:
- To review CRRT techniques, indications, and complications.
- To examine drug removal principles and dosage individualization during CRRT.
- To assess the influence of CRRT on patient outcomes.
Main Methods:
- A comprehensive literature search of MEDLINE (1981-1996) was conducted.
- Keywords included hemofiltration, hemodialysis, pharmacokinetics, and medications.
- Selected articles focused on CRRT principles and drug disposition.
Main Results:
- CRRT utilizes filtration/convection and diffusion for fluid overload and acute renal failure.
- Poor outcomes are associated with advanced age, ventilator support, and elevated bilirubin.
- CRRT complicates medication regimens, necessitating careful drug dosage adjustments based on drug and procedure characteristics.
Conclusions:
- CRRT use has broadened beyond acute renal failure management.
- Variability in CRRT practices makes it premature to claim enhanced survival over conventional hemodialysis.
- Individualizing CRRT and optimizing pharmacotherapy are crucial for patient care.