[Continuous renal replacement therapies (CRRT)]

Abstract

Several techniques are currently available in the continuous renal replacement therapy (CRRT) spectrum, adhering to different clinical conditions and illness severity. Commercially available machines have become more user-friendly, even for non-dialysis staff however, nephrologists need specific knowledge to give an adequate prescription that must be different from chronic hemodialysis. Competence and experience in the technical possibilities of CRRT lead to an individual ultra-filtration and treatment dose prescription. Clearances of solutes with different molecular weight can be modulated by coupling (combining) diffusion and convection, and by changing the fluid infusion rate. In addition, CRRT has an important impact on metabolism with its cooling effect, removal of nourishing substances and modification of electrolytic and acid-base balance. In septic patients standard CRRT has no specific indications in the absence of acute renal failure. Other extracorporeal therapies, such as high volume hemofiltration coupled with plasma filtration-adsorption (CPFA), have been developed aiming for a major influence on sepsis evolution. The versatility of CRRT has great value not only in adapting the treatment schedule to clinical conditions, but also in performing extracorporeal therapies in a wide array of logistical circumstances.