SLEDD and Hybrid Renal Replacement Therapies for Acute Renal Failure in the ICU
Acute renal failure with need for renal replacement therapy in the intensive care unit (ICU) is a complex and devastating condition, with a reported mortality rate as high as 50–80% [1, 2]. Although gross mortality rates have only declined slightly over the past decades, it is accepted that survival has enhanced by improvement in overall care, since the comorbidity of patients and the severity of the diseases treated has also increased dramatically . Although acute renal failure by itself contributes to the overall mortality of critically ill patients, it is important to understand that acute renal failure mostly develops as a consequence of other underlying comorbidities, and that patients often do not die of their acute renal failure but from these underlying conditions. Thus, the idea that by inventing ‘the perfect renal replacement therapy-machine’, no more patients with ICU-related acute renal failure will die, will remain an illusion. Furthermore, acute renal failure mostly recovers if the patient survives. Renal replacement therapy in acute renal failure should thus be seen as a bridging therapy that allows the patient to survive while the native kidneys recover. The main objective of renal replacement therapy should, thus, be to avoid additional harm to the patient as much as possible while clearing the uremic waste products and maintaining the ‘milieu interieur’ as closely possible to normal.
KeywordsIntensive Care Unit Acute Renal Failure Renal Replacement Therapy Intensive Care Unit Patient Continuous Renal Replacement Therapy
Unable to display preview. Download preview PDF.
- 7.Mehta RL, Letteri JM (1999) Current status of renal replacement therapy for acute renal failure. A survey of US nephrologists. The National Kidney Foundation Council on Dialysis. Am J Nephrol 19: 377–382Google Scholar
- 21.Paganini EP, Sandy D, Moreno L, Kozlowski L, Sakai K (1996) The effect of sodium and ultrafiltration modelling on plasma volume changes and haemodynamic stability in intensive care patients receiving haemodialysis for acute renal failure: a prospective, stratified, randomized, cross-over study. Nephrol Dial Transplant 11 (suppl 8): 32–37PubMedCrossRefGoogle Scholar
- 23.Kumar VA, Craig M, Depner TA, Yeun JY (2000) Extended daily dialysis: A new approach to renal replacement for acute renal failure in the intensive care unit. Am J Kidney Dis 36: 294–300Google Scholar
- 25.Tapolyai M, Fedak S, Chaff C, Paganini EP (1994) Delivered dialysis dose may influence acute renal failure outcome in ICU patients. J Am Soc Nephrol 5: 530A (abst)Google Scholar
- 32.Fassbinder W (1998) Renaissance of the batch method? Nephrol Dial Transplant 13: 30103012Google Scholar
- 35.Dhondt A, Vanholder R, DeSmet R, Glorieux G, Waterloos M, Lameire N (2003) Studies on dialysate mixing in the Genius(R)single pass batch system for hemodialysis therapy. Kidney Int (in press)Google Scholar
- 37.Williams PF, Foggensteiner L (2002) Sterile/allergic peritonitis with icodextrin in CAPD patients. Petit Dial Int 22: 89–90Google Scholar