(精编)【持续性肾脏替代治疗CRRT英文精品课件】CBP Nephrology – Diseases of the kidneys!(102p).ppt

Renal Replacement Therapy All forms of RRT rely on the principle of allowing water and solute transport through a semipermeable membrane and discarding waste products Fluid removal – ultrafiltration Solute transport – diffusion, convection, or both Question 8 IHD vs CRRT (Brian) Dialysis modality 1999 NKF survey revealed IHD as preferred form of RRT (75%), while CRRT + PD was less than 10% More recent survey revealed IHD as preferred by nephrologists/intensivists in 57%, while CRRT was preferred in 37% in US Internationally: BEST Kidney study (JAMA 2005) revealed CRRT as the initial modality of choice for RRT in ICU used in 80%, followed by IHD (17%) So: is CRRT better? Preference of CRRT – Putative advantages Improved hemodynamic stability More effective control of acid/base and electrolyte status Improved removal of uremic toxins Removal of inflammatory mediators Disadvantages Need for anticoagulation 2-3x more expensive than IHD Evidence Two 2002 metaanalyses of earlier trials comparing survival in ICU AKI assigned to IHD or CRRT and adjusted for severity of illness did not support CRRT Several observational and prospective RCTs comparing IHD vs CRRT failed to confirm expected survival advantage of CRRT Limitations: dose difference, high crossover rate, randomization failure, nonstandardization of protocol Cochrane Review 2008 Intermittent vs. continuous RRT for ARF in adults Objectives To compare CRRT with IRRT to establish if any of these techniques is superior to each other in patients with AF Methods Types of studies: RCTs Interventions IRRT defined as any form of RRT (HD, HF, HDF, UF) prescribed for period of 24h within any 24h period CRRT defined as any RRT intended to run on a continuous basis until recovery of renal function occurred Question 6 When should RRT be started? (Indication and timing) (Brian) Historical aspects Use of HD in ARF started in the years immediately following WWII (1947-1950) Initial indications: advanced symptoms of renal failure