Continuous renal replacement therapy versus intermittent hemodialysis in intensive care patients: impact on mortality and renal recovery

van Bommel EFH, Leunissen KML, Weimar W. Continuous renal replacement therapy for critically ill patients: an update. J Intensive Care Med 1994; 9: 265–280. Despite continuous progress in intensive care during the last decades, the outcome of critically ill patients in whom acute renal failure (ARF) develops is still poor. This outcome may be explained partially by the frequent occurrence of ARF as part of multiple organ systems failure (MOSF). In this complex and unstable patient population, the provision of adequate renal support with either intermittent hemodialysis or peritoneal dialysis may pose major problems. Continuous renal replacement therapy (CRRT) is now increasingly accepted as the preferred treatment modality in the management of ARF in these patients. The technique offers adequate control of biochemistry and fluid balance in hemodynamically unstable patients, thereby enabling aggressive nutritional and inotropic support without the risk of exacerbating azotemia or fluid overload. In addition, experimental and clinical data suggest that CRRT may have a beneficial influence on hemodynamics and gas exchange in patients with septic shock and (nonrenal) MOSF, independent of an impact on fluid balance. We review both technical and clinical aspects of various continuous therapies, including their impact on serum drug levels and nutrient balance. In addition, an attempt is made to clarify the possible beneficial role of CRRT in reducing patient morbidity and mortality in the ICU.

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The doripenem serum concentrations in intensive care patients suffering from acute kidney injury, sepsis, and multi organ dysfunction syndrome undergoing continuous renal replacement therapy slow low-efficiency dialysis

Drug Design Development and Therapy ◽

10.2147/dddt.s64942 ◽

2014 ◽

pp. 2039

Author(s):

Tomasz Gaszynski ◽

Andrzej Wieczorek ◽

Andrzej Tokarz ◽

Wojciech Gaszynski

Keyword(s):

Acute Kidney Injury ◽

Intensive Care ◽

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Kidney Injury ◽

Serum Concentrations ◽

Intensive Care Patients ◽

Low Efficiency ◽

Multi Organ Dysfunction Syndrome

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What Is the Renal Replacement Method of First Choice for Intensive Care Patients?

Journal of the American Society of Nephrology ◽

10.1681/asn.v12suppl_1s40 ◽

2001 ◽

Vol 12 (suppl 1) ◽

pp. S40-S43

Author(s):

RAYMOND VANHOLDER ◽

WIM VAN BIESEN ◽

NORBERT LAMEIRE

Keyword(s):

Intensive Care ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Care Patient ◽

Intermittent Hemodialysis ◽

Intensive Care Patients ◽

Replacement Method ◽

First Choice ◽

Daily Dialysis ◽

Dialysis Membranes

Abstract.Renal replacement therapy for the patient with acute renal failure on the intensive care unit can be offered in several different formats: intermittent hemodialysis (IHD), continuous renal replacement therapy (CRRT), and slow low-efficient daily dialysis (SLEDD). It is frequently claimed that CRRT offers several advantages over IHD, but most of these, such as correction of metabolic acidosis, better recovery of renal function, better clinical outcome due to application of biocompatible dialysis membranes, correction of malnutrition, and better removal of cytokines, are not corroborated by the results of controlled prospective studies. There is also no evidence that CRRT results in a better surival, compared with IHD. The only potential advantages of CRRT that stood the test of clinical evaluation (hemodynamic stability, correction of hypervolemia, better solute removal) can be offered as well by SLEDD. In addition, the latter strategy is less expensive because the same infrastructure is used as for IHD, while the patient is not immobilized continuously, which leaves time free for other activities such as nursing care and technical investigations. SLEDD is a relatively young technique, so thorough clinical studies are lacking. Nevertheless, the hypothesis is proposed that SLEDD offers a valuable alternative to the classical dialysis strategies, applied in the intensive care patient.

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