Innovations in technology
New CRRT systems: Impact on dose delivery

https://doi.org/10.1016/S0272-6386(97)90537-0Get rights and content

Abstract

The evolution of technology and biomaterials has permitted a parallel development of renal replacement therapies in the acute, critically ill patient. From the original description of continuous arteriovenous hemofiltration, new techniques such as continuous venovenous hemofiltration, hemodiafiltration, and high flux dialysis have been developed and clinically used. A parallel improvement in efficiency has been achieved with urea daily clerances as high as 50 L or more. The use of special highly permeable dialyzers has also permitted an increase in the clearances of larger solutes, thus leading to significant removals of chemical substances involved in acute inflammation and sepsis. In this field, recent observations have suggested using hemofiltration with high volumes of fluid exchange. The hardware and software of the newer CRRT systems are key in achieving these results and in safely performing such challenging techniques.

References (27)

  • AF Grootendorst et al.

    Infusion of ultrafiltrate from endotoxemic pigs depresses myocardial performance in normal pigs

    J Crit Care

    (1993)
  • C Ronco et al.

    Management of acute renal failure in the critically ill patient

  • R Bellomo et al.

    Acute renal failure in the intensive care unit: Which treatment is the best?

  • C Ronco et al.

    Adequacy of renal replacement therapy

  • C Ronco

    Continuous renal replacement therapies in the treatment of acute renal failure in intensive care patients. Part 2: Clinical indications and prescription

    Nephrol Dial Transplant

    (1994)
  • P Kramer et al.

    Arteriovenous hemofiltration: A new and simple method for treatment of over hydrated patients resistant to diuretics

    Klin Wochenschr

    (1977)
  • A Lauer et al.

    Continuous arterio-venous hemofiltration in the critically ill patient

    Ann Intern Med

    (1983)
  • A Kaplan et al.

    Continuous arterio-venous hemofiltration

    Ann Intern Med

    (1984)
  • R Geronemus et al.

    Continuous arterio-venous hemodialysis: a new modality for treatment of acute renal failure

    Trans ASAIO

    (1984)
  • C Ronco

    Arterio-venous hemodiafiltration (AVHDF): A possible way to uncrease urea removal during CAVH

    Int J Artif Organs

    (1985)
  • C Ronco et al.

    Arteriovenous hemodiafiltration associated with continuous arteriovenous hemofiltration. A combined therapy in the hypercatabolic patient

  • C Ronco et al.

    Complications with continuous renal replacement therapies

    Am J Kidney Dis

    (1996)
  • C Ronco

    Continuous renal replacement therapies in the treatment of acute renal failure in intensive care patients. Part 1: Theoretical aspects and techniques

    Nephrol Dial Transplant

    (1994)
  • View full text