Anest. intenziv. Med. 2006;17(2):99-101

Renal replacement therapy in critically ill patients: 2005 updateIntensive Care Medicine

I. Novák, M. Matějovič, A. Kroužecký, J. Raděj

Jednotka intenzivní péče I. interní kliniky, Fakultní nemocnice a Lékařská fakulta UK, Plzeň

Renal replacement therapy (RRT) is needed in 50% to 70% of patients with sepsis-related acute renal failure (ARF) in the ICU. The ARF in this setting is often accompanied by multiple organ dysfunction and is associated with very high mortality (53% to 73%). Thus, there is a great deal of interest in developing renal replacement strategies to reduce the mortality rate.Traditional intermittent haemodialysis in the treatment of ARF offers good metabolic control but poor haemodynamic tolerance, especially in septic patients. Haemofiltration is the more commonly used method in septic shock due to its better haemodynamic tolerance, and it is argued that haemofiltration can reverse the sepsis-related inflammatory response, even in the absence of ARF.This emphasises the potential role of the early initiation of haemofiltration in sepsis. Some new developments in blood purification for sepsis, including high-flux haemofiltration, high-volume haemofiltration, and the use of sorbents, remain under investigations. Current evidence is insufficient to draw strong conclusions regarding the method of RRT for ARF in septic patients.

Keywords: acute renal failure; sepsis; multiple organ failure; haemopurification; haemofiltration

Published: April 1, 2006  Show citation