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Continuous renal replacement therapies
(CRRT) have emerged as the defacto method in critical care.
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CRRT ensures adequate creatinine clearance in a hemodynamically stable environment.
CRRT is superior to intermittent hemodialysis for volume control.
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Hemodynamic stability may have the
added advantage of preventing secondary ischemic injury to the kidneys
due to hypotensive episodes during hemodialysis.
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The biggest single
problem encountered with continuous hemodiafiltration is the necessity
for anticoagulation in patients who are, invariably, coagulopathic or
bleeding.
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Care must be taken
to ensure electrolyte balance, ideally the content of the dialysate
should mirror that of the ideal blood electrolyte composition.
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Due to the tendency
for bicarbonate to caused precipitation, it is usually replaced by
lactate in dialysis solutions. However, if the patient is in a state of
liver failure, this lactate may not be metabolized, and may cause an
academia.
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Hemofiltration may
have a role in the management of septic patients, as a plasma cytokine
filter, modulating the inflammatory response, but there is no evidence
that this alters outcomes in humans.
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