Abstract
Endogenous toxins accumulate in blood as a result of many biochemical processes.1 If their concentration exceeds certain levels, they cause illness. Some toxins are volatile (e.g., CO2, ketones) and can be excreted by the lungs through ventilation; others are lipophilic (e.g., bile acids, bilirubin) and can be excreted by the liver via the biliary system; yet others are water soluble and nonvolatile and are excreted by the kidneys.2 When acute kidney injury (AKI) occurs, these water-soluble substances (potassium, phosphate, urea, creatinine) and endogenous toxins (methylguanidine, guanidinosuccinic acid, hippuric acid, uric acid, phenols, beta-2 microglobulin, purines, myo-inositol, etc.), which are normally excreted by the kidney, accumulate in blood. If accumulation progresses, AKI becomes severe; and if their removal is not addressed by either renal recovery or the initiation of artificial renal replacement therapy, the patient dies from uncontrolled hyperkalemia or uremia. Unfortunately, AKI requiring renal replacement therapy (RRT) is relatively common in critically ill patients treated in the intensive care unit (ICU) and involves close to 5% of all admissions.3 When a decision is made that artificial renal replacement therapy is needed, the physician has a variety of techniques at his/her disposal: intermittent hemodialysis (IHD), continuous renal replacement therapy (CCRT), slow extended daily dialysis (SLEDD), and peritoneal dialysis, each with its technical variations. All of these techniques rely on the principle that unwanted solutes and water can be removed through a semipermeable membrane-based separating process. The principles of such process have been extensively studied and described.4,5
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Vanhoder R, De Smet R, Glorieux G, et al. Review on uremic toxins: classification, concentration, and interindividual variabiity. Kidney Int. 2003;63:1934–1943.
Macias WL, Clark WR. Azotemia control by extracorporeal theraphy in patients with acute renal failure. New Horiz. 1995;3:688–693.
Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicanter study. JAMA. 2005;294:813–818.
Sargent J, Gotch F. Principles and biophysics of dialysis. In: Maher JF, editor. Replacement of renal function by dialysis. Dordecht, The Netherlands: Kluwer Academic Publishers; 1989.
Henderson L. Biophysic of ultrafiltration and hemofiltration. In: Maher JF, editor. Replacement of renal function by dialysis. Dordecht, The Netherlands: Kluwer Academic Publishers; 1989.
Bellomo R, Metha R. Acute renal replacement in the intensive care unit: now and tomorrow. New Horiz. 1995;3:170–767.
Kellum JA. Primun non nocere and the meaning of modern critical care. Curr Opin Crit Care. 1998;4:400–405.
Hakim RM. Clinical implications of hemodialysis membrane biocompatibility. Kidney Int. 1993;44:484–494.
Ronco C, Brendolan A, Bellomo R. Current technology for continuous renal replacement therapies. In: Ronco B, editor. Critical care nephrology. Dordecht, The Netherlands: Kluwer Academic Publishers; 1998.
Ronco C, Tetta C, Lupi A. Removal of platelet activating factor by continuous haemofiltration. Crit Care Med. 1995;23:99–107.
Bellomo R, Tipping P, Boyce N. Continuous venovenous hemofiltration with dialysis removes cytokines from the circulation of septic patients. Crit Care Med. 1993;21:522–526.
Blake PG, Daugirdas JT. Physiology of peritoneal dialysis. In: Daugirdas JT, Blafe PJ, Ing TS, editors. Handbook of dialysis. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2000. p. 281–296.
Chatoth DK, Shaver MJ, Marshall MR, et al. Daily 12-hour sustained low-efficiency hemodialysis (SLED) for the treatment of critically ill patients with acute renal failure: initial experience. Blood Purif. 1999;17:Abstract 16
Paganini EP. Dialysis is not dialysis is not dialysis! Acute dialysis is different and needs help!. Am J Kidney Dis. 1998;32:832–833.
Bellomo R, Ronco C. Adequacy of dialysis in the acute renal failure of the critically ill: the case for continuous therapies. Int J Artuf Organs. 1996;19:129–142.
Ronco C, Bellomo R, Homel P, et al. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomized trial. Lancet. 2000;355:26–30.
Marshall MR, Golper TA, Shaver MJ, et al. Hybrid renal replacement modalities for the critically ill. Contrib Nephrol. 2001;132:252–257.
Saudan P, Niederberger M, De Seigneux S, et al. Adding a dialysis dose to continuous hemofitlration increases survival in patients with acute renal failure. Kidney Int. 2006;70:1312–1317.
Bellomo R. Do we know the optimal dose for renal replacement therapy in the intensive care unit? Kidney Int. 2006;70:1202–1204.
Mehta R, Dobos GJ, Ward DM. Anticoagulation procedures in continuous renal replacement. Seminars Dial. 1992;5:61–68.
Naka T, Egi M, Bellomo R, et al. Low-dose citrate continuous veno-venous hemofiltration and acid-base balance. Int J Artif Organs. 2005;28:222–228.
Tan HK, Baldwin I, Bellomo R. Hemofiltration without anticoagulation in high-risk patients. Intensive Care Med. 2000;26:1652–1657.
Ronco C, Brendolan A, Bellomo R. Current technology for continuous renal replacement therapies. In: Ronco C, Bellomo R, editors. Critical care nephrology. Dordrecht, The Netherlands: Kluwer Academic Publishers; 1998. p. 1327–1334.
Uchino S, Bellomo R, Kellum JA, et al. Patient and kidney survival by dialysis modality in critically ill patients with acute kidney injury. Int J Artif Organs. 2007;30:281–292.
Davenport A. The management of renal failure in patients at risk of cerebral edema/hypoxia. New Horiz. 1995;3:717–724.
Phu NH, Hien TT, Mai NT, et al. Hemofiltration and peritoneal dialysis in infection-associated acute renal failure in Vietnam. N Engl J Med. 2002;347:895–902.
Reeves JH, Butt WW, Shann F, et al. Continuous plasmafiltration in sepsis syndrome. Crit Care Med. 1999;27:2096–2104.
Cole L, Bellomo R, Journois D, et al. High volume hemofiltration in human septic shock. Intensive Care Med. 2001;27:978–986.
Brendolan A, Bellomo R, Tetta C, et al. Coupled plasma filtration adsorption in the treatment of septic shock. Contrib Nephrol. 2001;132:383–391.
Haase M, Bellomo R, Baldwin I, et al. Hemodialysis membrane with a high-moluclar weigth cutoff and cytokine levels in sepsis complicated by acute renal failure: a phase I randomized trial. Am J Kidney Dis. 2007;50:296–304.
Mitzner SR, Stange J, Klammt S, et al. Extracorporeal detoxification using the molecular adsorbent recirculating system for critically ill patients with liver failure. J Am Soc Nephrol. 2001;12:S75–S82.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2010 Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Licari, E., Calzavacca, P., Bellomo, R. (2010). Renal Replacement Therapy. In: O’Donnell, J.M., Nácul, F.E. (eds) Surgical Intensive Care Medicine. Springer, Boston, MA. https://doi.org/10.1007/978-0-387-77893-8_39
Download citation
DOI: https://doi.org/10.1007/978-0-387-77893-8_39
Publisher Name: Springer, Boston, MA
Print ISBN: 978-0-387-77892-1
Online ISBN: 978-0-387-77893-8
eBook Packages: MedicineMedicine (R0)