Acute Renal Failure and Renal Replacement Techniques

Acute renal failure (ARF) is a common event in critical patients usually taking place in a multiorganic failure context. This disorder implies a great clinical challenge. ARF could be defined as a sudden deterioration of the renal function that results in a loss of electrolyte, acid-base and fluid balance control, with subsequent accumulation of nitrogen wastes. Although ARF can appear in a wide range of patients and conditions, its physiopathological bases is shared by most episodes with the hipoperfusion and/or renal ischemia as a triggering of the injury. Shock, and specially septic shock is the main cause of ARF leading to renal replacement techniques. Though in the last twenty years continuous extracorporeal purification techniques have experienced an extraordinary growth, mortality remains high (50-70%). At present predominance of the continuous renal replacement therapy (CRRT) versus intermittent hemodialysis (IHD) is based on its better hemodynamic stability, great versatility in the hydroelectrolytic handling, favored gaseous exchange and improvement of the ventricular filling pressures, low extracorporeal blood volume, smaller activation of the complement, preferred elimination of fluids from the interstitial space, low rate of complications, control of uremia and the intravascular volume without protein or hydric restriction, possibility of elimination of certain toxics, good tolerance in patients with intracranial hypertension and no need of specialized personnel. CRRT and related procedures are an effective and feasible treatment in patients with acute renal failure, severe cardiovascular instability, multisystem organ failure or politraumatized patients, being a simple and easy choice to implement and monitor. KEY WORDS—Acute renal failure. Continuous renal replacement therapy. Hemodialysis. Acute kidney injury. Renal replacement techniques. MEDICRIT 2008; 5(4):115-29 Medicrit © 2008. Derechos Reservados. Acute Renal Failure and Renal Replacement Techniques Ernesto García Vicente, M.D.,1 Carlos Aguilar Franco, M.D., PhD.,2 Valentín del Villar Sordo, M.D., PhD.,3 Ernesto Luis García y García, M.D., PhD.,4 Ma Raquel Pellicer Algora, L.C.E.5 m e d i c r i t o c t u b r e 2008; 5(4) :115-29 w w w.m e d i c r i t .c o m 1Intensivist; Intensive Care Unit, Santa Bárbara Hospital; — 2Hematologist; Hematology Department. Santa Bárbara Hospital; — 3 Chief of Internal Medicine, Santa Bárbara Hospital; — 4Chief of Rehabilitation and Physical Medicine. Miguel Servet Hospital. Zaragoza. Spain; — 5Nursing Department. Santa Bárbara Hospital. Santa Bárbara Hospital. Po Santa Bárbara s/n 42004. Soria. Spain. Phone number: 975234300. Fax Number: 975234324. Corresponding author: Ernesto García Vicente. Avda. De la Constitución no 10, 1o B. 42004. Soria. Spain. Phone number: 607662049. e-mail: [email protected] Citation: García E, Aguilar C, del Villar V, García EL, Pellicer R. Acute Renal Failure and Renal Replacement Techniques. Medicrit 2008; 5(4):115-29. This article ́s authors declare not having competing interests. NLMID: 101253595 Incluida en el Catálogo de National Library of Medicine, USA. Indexada en la Red de Revistas Científicas de América Latina y el Caribe, España y Portugal REDALYC, IMBIOMED y en PERIÓDICA, Base de datos de la Universidad Nacional Autónoma de México. Para comentarios sobre este artículo, favor dirigirse a: [email protected] r e v i e w a r t i c l e