PMID- 19255959
OWN - NLM
STAT- MEDLINE
DCOM- 20090720
LR  - 20151119
IS  - 0393-5590 (Print)
IS  - 0393-5590 (Linking)
VI  - 26
IP  - 1
DP  - 2009 Jan-Feb
TI  - [Continuous renal replacement therapies (CRRT) will remain the most widely 
      adopted dialysis modality in the critically ill].
PG  - 13-21
AB  - In the last 10-15 years, user-friendly continuous renal replacement therapy 
      (CRRT) machines have played a major role in increasing the popularity of these 
      techniques in intensive care settings. At present it is not clear which modality 
      of renal replacement therapy (RRT) is optimal for critically ill patients with 
      acute kidney injury (AKI). The choice between different modalities should 
      therefore not be based on unproven ''outcome'' advantages but on evaluation of 
      the clinical picture and logistical circumstances. In hypercatabolic patients, 
      CRRT and sustained low-efficiency dialysis (SLED) have been shown to provide 
      similar metabolic control, but uncontrolled studies suggested a better 
      hemodynamic stability during CRRT, intended as a higher mean arterial pressure 
      and/or less frequent need to increase inotropic or vasoactive drugs. The 
      incidence of hemorrhagic complications is higher with CRRT; however, in 
      particular conditions, such as in patients at high risk of bleeding, CRRT can be 
      performed without anticoagulation or with the use of alternative anticoagulation 
      protocols. Among the different modalities, regional anticoagulation with citrate 
      appears to be the most promising, and the continuous development of simplified 
      protocols for citrate CRRT might facilitate the more extensive use of this 
      technique in the near future. The presence of a mismatch between prescribed and 
      delivered dialysis dose is frequently reported as an important drawback of CRRT. 
      However, data from a recent study designed to evaluate the prognostic impact of 
      the intensity of renal support in critically ill patients with AKI showed that 
      the target Kt/V was obtained in only 67-69% of intermittent hemodialysis (IHD) 
      sessions. Data from several studies comparing the costs of different RRT 
      modalities showed that CRRT is more expensive than IHD or SLED. However, the 
      costs related to SLED can fluctuate within a wide range and in particular 
      settings the higher costs of CRRT could be partially justified by logistical 
      advantages. Further improvements in CRRT device characteristics, anticoagulation 
      protocols, and adaptation of dialysis/replacement fluids to clinical needs will 
      possibly contribute to maintaining, in the coming years, the key role of CRRT in 
      the treatment of hemodynamically unstable critically ill patients requiring RRT.
FAU - Morabito, S
AU  - Morabito S
AD  - Nefrologia e Dialisi, Dipartimento Nefro-Urologia, Policlinico Umberto I, 
      Universita' degli Studi La Sapienza, Roma, Italy. santo.morabito@uniroma1.it
FAU - Pistolesi, V
AU  - Pistolesi V
FAU - Cibelli, L
AU  - Cibelli L
FAU - Pierucci, A
AU  - Pierucci A
LA  - ita
PT  - English Abstract
PT  - Journal Article
TT  - A favore delle CRRT: le terapie sostitutive renali continue rimarranno le 
      metodiche prevalenti nelle unita' di terapia intensiva.
PL  - Italy
TA  - G Ital Nefrol
JT  - Giornale italiano di nefrologia : organo ufficiale della Societa italiana di 
      nefrologia
JID - 9426434
RN  - 0 (Anticoagulants)
SB  - IM
MH  - Acute Kidney Injury/therapy
MH  - Anticoagulants/therapeutic use
MH  - Critical Care
MH  - Critical Illness
MH  - Humans
MH  - Renal Replacement Therapy/*methods
EDAT- 2009/03/04 09:00
MHDA- 2009/07/21 09:00
CRDT- 2009/03/04 09:00
PHST- 2009/03/04 09:00 [entrez]
PHST- 2009/03/04 09:00 [pubmed]
PHST- 2009/07/21 09:00 [medline]
PST - ppublish
SO  - G Ital Nefrol. 2009 Jan-Feb;26(1):13-21.