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Related Experiment Videos

Continuous renal replacement therapies: an update

M Manns1, M H Sigler, B P Teehan

  • 1Division of Nephrology, Lankenau Hospital, Wynnewood, PA 19096-3426, USA.

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|August 26, 1998
PubMed
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Continuous renal replacement therapy (CRRT) offers benefits like hemodynamic stability for critically ill patients. However, its impact on patient outcomes requires further study, and intermittent hemodialysis is preferred for specific conditions.

Area of Science:

  • Nephrology and Critical Care Medicine

Background:

  • Continuous renal replacement modalities are widely used for acute renal failure management.
  • These therapies offer advantages such as hemodynamic stability and improved fluid balance.

Purpose of the Study:

  • To review the advantages and disadvantages of continuous renal replacement therapies (CRRT).
  • To discuss the clinical applications and indications for CRRT in critically ill patients.
  • To compare CRRT with intermittent hemodialysis for specific patient populations.

Main Methods:

  • Review of continuous renal replacement modalities, including access, clearance types, and fluid delivery.
  • Discussion of CRRT advantages (hemodynamic stability, alimentation, fluid balance, gradual urea removal).
  • Analysis of CRRT disadvantages (anticoagulation, immobilization, side effects) and comparison with intermittent therapies.

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Main Results:

  • CRRT improves management of critically ill patients, especially those with volume overload and sepsis.
  • Continuous hemofiltration for cytokine removal in sepsis remains controversial.
  • CRRT is less effective for intoxication, severe hyperkalemia, or acidosis compared to intermittent methods.

Conclusions:

  • CRRT simplifies management for hemodynamically unstable, critically ill patients with acute renal failure.
  • Intermittent hemodialysis is preferred for non-critically ill patients and those with hemorrhagic diathesis.
  • Further clinical assessment is needed for CRRT's role in specific conditions like sepsis-induced cytokine removal.