Renal Replacement Therapy in Critical Care

Introduction

Patients on medical wards who develop renal failure are conventionally treated conservatively. The principle (non) intervention is fluid restriction. This is rarely possible in intensive care due to the large amounts of carrier fluids required for antibiotics and other drugs and the compulsion to feed these patients, to arrest catabolism and preserve physiologic reserve. In addition, patients in intensive care units often have multi-system involvement, and these systems may be further injured by fluid overload, electrolyte and acid base imbalance.
In the last tutorial, we addressed methods for overcoming the problem of oliguria as it evolves into acute renal failure, in particular the influence of diuretics. This method is inexpensive, with little  potential for harm and has the advantage of controlling overall fluid balance. Diuresis, alone, may not prevent uremia, acidosis and hyperkalemia.
The use of artificial kidneys began during the Korean War, when it was called “dialysis”, derived from Greek and meaning “to pass across”. During the past 50 or so years, we have moved on to using the term “renal replacement therapies (RRT)” to describe hemodialysis and its progeny – peritoneal dialysis, continuous hemofiltration and continuous hemodialfiltration. In this tutorial we will look at the use of these techniques in intensive care.

Learning Objectives

• To understand the indications for renal replacement therapy (RRT)
• To understand the mechanisms of action of various RRTs are based
• To differential between the various methods of RRT
• To prescribe RRT for an ICU patient

Please note: these tutorials are for personal study purposes only.  They are not currently peer reviewed, and no responsibility will be taken for mistakes or inaccuracies. Reproduction of information is forbidden. All material is copyrighted by the GasWorks Group.