Vnitr Lek 1996, 42(12):818-824

[Methods of continuous extracorporeal replacement of renal function].

K Opatrný: I. interní klinika LF UK, Plzen.

Methods of continuous renal replacement therapy are used to an increasing extent also in this country. The oldest one, continuous arteriovenous haemofiltration has been supplemented by continuous haemodialysis, hemodiafiltration and high-flux dialysis. An alternative of the arteriovenous vascular access is the veno-venous one. Indication for continuous renal replacement therapy are patients with acute renal failure in a critical condition, i.e. in particular patients with acute renal failure as part of multiorgan failure and patients with an unstable circulation. In this indication methods of continuous renal replacement therapy were accepted due to their effective and safe character. Moreover so far evidence was not yet provided that continuous methods lead to longer survival of patients with acute renal failure than intermittent dialysis or other intermittent methods of renal replacement therapy. So far it has not been proved that continuous methods are an asset in the treatment of conditions such as sepsis/septic shock, necrotizing pancreatitis, syndrome of acute respiratory distress (ARDS) and others, if the renal function is preserved. Problems of indication and comparison with intermittent procedures must be resolved in subsequent well planned studies. Problems which must be dealt with in future are technical innovations which will increase the effectiveness of the procedures, e.g. by making fuller use of adsorption, and problems of hemocompatibility, in particular in relation to the thrombogenicity of the extracorporeal circulation and the associated administration of anti-thrombotic drugs.