Continuous renal replacement therapy: continuous blood purification in the intensive care unit

Area of Science:

• Nephrology
• Intensive Care Medicine
• Critical Care

Background:

• Severe acute renal failure (SARF) is increasingly prevalent in intensive care units (ICUs), often associated with multiorgan failure.
• Treatment paradigms for SARF have evolved from traditional nephrology-led intermittent hemodialysis to intensivist-led continuous renal replacement therapy (CRRT), especially in Europe and Australia.

Purpose of the Study:

• To explore the evolving role of CRRT in managing critically ill patients with SARF.
• To investigate the potential of CRRT as an adjunctive therapy for sepsis, beyond its traditional role in maintaining homeostasis.

Main Methods:

• Review of the current literature on SARF and CRRT in critical care settings.
• Discussion of the physiological effects and clinical advantages of CRRT in critically ill patients.
• Examination of emerging research on CRRT's impact on sepsis and inflammation.

Main Results:

• CRRT offers significant advantages in critically ill patients, including hemodynamic stability, fluid balance control, uremic control, and nutritional support.
• Animal studies suggest CRRT can attenuate hemodynamic compromise in sepsis and that increased fluid exchange may enhance these benefits.
• Pilot human trials are investigating CRRT's efficacy in mitigating sepsis-induced inflammation.

Conclusions:

• CRRT has become a cornerstone in managing SARF within ICUs, providing multifaceted benefits for critically ill patients.
• Emerging evidence supports CRRT's potential as an adjuvant therapy for sepsis, aiming to reduce inflammatory responses.
• The application of CRRT may expand to encompass broader management strategies for multiorgan dysfunction and sepsis.