Continuous renal replacement therapies: Overview
- Author
- Thomas A Golper, MD
Thomas A Golper, MD
- Section Editor — Dialysis
- Professor of Medicine
- Vanderbilt University Medical Center
- Section Editor
- Steve J Schwab, MD
Steve J Schwab, MD
- Editor-in-Chief — Nephrology
- Section Editor — Dialysis
- Chancellor
- University of Tennessee Health Science Center
- Deputy Editor
- Alice M Sheridan, MD
Alice M Sheridan, MD
- Deputy Editor — Nephrology
- Assistant Professor of Medicine
- Harvard Medical School
INTRODUCTION
Continuous renal replacement therapies (CRRTs) involve either dialysis (diffusion-based solute removal) or filtration (convection-based solute and water removal) treatments that operate in a continuous mode [1-4]. Variations of CRRT might run 12 to 14 hours, especially during daytime periods of full staffing. This regimen has become more prevalent in Europe and has been called "go slow dialysis." Other variations of this technique are discussed below and probably should be called hybrid therapies because they are a merging of intermittent and continuous duration. The longer duration of CRRT makes it quite different from conventional intermittent hemodialysis, in which each treatment lasts four to six hours or less.
The major advantage of continuous therapy is the slower rate of solute or fluid removal per unit of time. Thus, CRRT is generally better tolerated than conventional therapy since many of the complications of intermittent hemodialysis are related to the rapid rate of solute and fluid loss. (See "Renal replacement therapy (dialysis) in acute kidney injury (acute renal failure): Metabolic and hemodynamic considerations".)
TERMINOLOGY
There are many variations of CRRT, and this topic review will provide a general overview of the nomenclature that has been developed. The different modalities are categorized according to the access characteristics: blood or peritoneal, venovenous (VV) or arteriovenous (AV) (table 1).
Arteriovenous or venovenous — AV refers to the use of an arterial catheter that allows blood to flow into the extracorporeal circuit by virtue of the systemic blood pressure. A venous catheter is placed for return. VV is an alternative modality in which both catheters or one dual-lumen catheter is placed in veins. An extracorporeal blood pump is required to circulate blood through the extracorporeal circuit.
The advantage of AV access is that it is simple to set up and does not require an extracorporeal blood pump. It does, however, require arterial puncture, with an attendant risk of arterial embolization. Blood flow may also be unreliable in patients who are hypotensive or have severe peripheral vascular disease.
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To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:Literature review current through: Jun 2017. | This topic last updated: Apr 21, 2015.The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.References- Manns M, Sigler MH, Teehan BP. Continuous renal replacement therapies: an update. Am J Kidney Dis 1998; 32:185.
- Kanagasundaram NS, Paganini EP. Critical care dialysis--a Gordian knot (but is untying the right approach?). Nephrol Dial Transplant 1999; 14:2590.
- Ronco C, Bellomo R, Kellum JA. Continuous renal replacement therapy: opinions and evidence. Adv Ren Replace Ther 2002; 9:229.
- Mehta RL. Continuous renal replacement therapy in the critically ill patient. Kidney Int 2005; 67:781.
- McCarthy JT, Moran J, Posen G, et al. A time for rediscovery: chronic hemofiltration for end-stage renal disease. Semin Dial 2003; 16:199.
- Honore PM, Jamez J, Wauthier M, et al. Prospective evaluation of short-term, high-volume isovolemic hemofiltration on the hemodynamic course and outcome in patients with intractable circulatory failure resulting from septic shock. Crit Care Med 2000; 28:3581.
- Palevsky PM. Dialysis modality and dosing strategy in acute renal failure. Semin Dial 2006; 19:165.
Top- INTRODUCTION
- TERMINOLOGY
- Arteriovenous or venovenous
- Hemodialysis
- Hemofiltration
- Hemodiafiltration
- CONTINUOUS REPLACEMENT THERAPIES
- Continuous arteriovenous hemofiltration
- Continuous venovenous hemofiltration
- Slow continuous ultrafiltration
- Continuous arteriovenous hemodialysis
- Continuous venovenous hemodialysis
- Continuous arteriovenous hemodiafiltration
- Continuous venovenous hemodiafiltration
- Continuous equilibrium peritoneal dialysis
- Continuous flow peritoneal dialysis
- Sustained low-efficiency or extended daily dialysis
- CHOICE OF THERAPY
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- REFERENCES