It has been more than 35 years since the early use of dialytic techniques for the treatment of acute renal failure. Considering the survival of patients who would have clearly succumbed to renal failure, attempts were made to determine at what level of uremic toxicity it would be beneficial to offer dialysis on a prophylactic basis. Those early attempts at defining a preventive strategy seemed to provide an improved survival by limiting incidence and severity of hemorrhage and sepsis. Subsequently, measurable advances have been difficult to attain, and the prognosis of complicated acute renal failure remained dismally poor. More recently, continuous renal replacement techniques were developed to offer a more physiologic treatment to those patients who were the most critically ill and unstable. These treatments offered the potential for a better tolerated fluid removal and a more constant control of electrolyte and acid-base balance. Other potential advantages included the use of more biocompatible membranes and the convective mode of solute transfer with its inherently greater removal of larger molecular weight substances such as the vasodilatory and inflammatory cytokines. Another approach has been to use extracorporeal purification to lower the levels of endotoxin, a goal which can be accomplished by either standard plasma exchange or, more elegantly, the use of selective adsorption columns. Despite the promise of these methodologies, the lack of an acceptable grading system for the severity of critical illness has hampered investigators who have tried to prove the eventual advantage of one blood purification technique over another.

Keywords:
Acute renal failure, Continuous arteriovenous hemofiltration, Continuous venovenous hemofiltration, Cytokines, Endotoxin, Multiorgan failure, Plasmapheresis
This content is only available via PDF.
© 1996 S. Karger AG, Basel
1996
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.