1,720,976 research outputs found
Determinants of haemodialyser performance and the potential effect on clinical outcome
No full textThe performance of a dialyser is determined by several factors. Many of these factors relate to the dialyser membrane, including mean pore size, pore size distribution, wall thickness, surface area, and adsorptivity. In this article, several of these factors are reviewed. The potential impact of these factors on the clinical outcome of chronic haemodialysis patients is also discussed
CRRT efficiency and efficacy in relation to solute size
No full textRemoval of blood solutes in patients with decreased or absent glomerular filtration is the prime objective of continuous renal replacement therapies (CRRTs). However, because these blood solutes are of different molecular weights, factors such as the porosity and hydrophobicity of the filter membranes and the extracorporeal flow rates determine the CRRT that is the most effective filtration system. This article discusses both small and large solute removal, the interaction of convection and diffusion, and the potential for CRRTs to remove particular inflammatory mediators of acute renal failure
Renal replacement therapy in acute renal failure: Solute removal mechanisms and dose quantification
No full textBased on numerous studies demonstrating a direct relationship between survival and delivered hemodialysis (HD) dose in end-stage renal disease (ESRD), quantification of delivered HD is now routinely performed in this setting. Recently, investigators have also begun applying kinetic modeling principles to quantify delivered dialysis dose in patients with acute renal failure (ARF). One purpose of this article is to review these ARF studies. However, a broader objective is to provide an overview of the solute removal capabilities of both intermittent and continuous therapies used in ARF. To achieve this goal, the dialytic removal mechanisms for solutes over a wide molecular weight spectrum are discussed
Reconciling differences in effective solute removal between intermittent and continuous therapies
No full textSolute removal by various forms of renal replacement therapy (RRT) differs from that occurring in the native kidney in several ways. Among the dialytic therapies, the relationship between clearance and mass removal rate may differ substantially. The purpose of this article is to review the various approaches that have been proposed to account for this differing relationship among the various types of RRT. Specific quantitative approaches along with clinical applications are provided
Recent clinical advances in the management of critically ill patients with acute renal failure
No full textBackground: Significant progress has been made in the field of renal replacement therapy for critically ill patients with acute renal failure (ARF) over the past few years. This review highlights these developments. Methods: Recent studies assessing the clinical utility of the RIFLE classification system for the diagnosis of ARF were reviewed. Clinical outcome studies evaluating the effect of continuous renal replacement therapy (CRRT) dose and timing of initiation were assessed. The final review topic was the effect of dialysis modality on the recovery of renal function in ARF patients. Conclusions: Based on recent clinical studies, the increasing use of the RIFLE criteria is justified, as this approach appears to be a robust method for both the diagnosis of and prognostication in ARF. A large randomized trial involving convective CRRT supports the commonly used prescription of 35 ml/kg/h in clinical practice. Moreover, numerous recent outcome studies, also largely involving convective CRRT, provide a clinical rationale for the increasingly common clinical practice of earlier initiation. Finally, several recent studies suggest CRRT, relative to conventional hemodialysis, results in a greater rate of renal recovery in ARF patients. Copyright (c) 2006 S. Karger AG, Basel
Operational characteristics of continuous renal replacement modalities used for critically ill patients with acute kidney injury
No full textRenal replacement therapy (RRT) is required in a significant percentage of patients developing acute kidney injury (AKI) in an intensive care unit (ICU) setting. One of the foremost objectives of continuous renal replacement therapy (CRRT) is the removal of excess fluid and blood solutes that are retained as a consequence of decreased or absent glomerular filtration. Because prescription of CRRT requires goals to be set with regard to the rate and extent of both solute and fluid removal, a thorough understanding of the mechanisms by which solute and fluid removal occurs during CRRT is necessary The following provides an overview of solute and water transfer during CRRT and this information is placed in the appropriate clinical context with a discussion of recent clinical trials assessing the relationship between CRRT dose and patient survival. Moreover, the differences between solute removal in CRRT and other dialysis modalities, especially sustained lowefficiency dialysis (SLED) and extended daily dialysis (EDD), along with the potential clinical implications are discussed
Solute removal by hollow-fiber dialyzers
No full textRenal replacement therapy performed for end-stage renal disease patients now occurs almost exclusively with hollow-fiber dialyzers. Because renal replacement therapy utilizing such a device requires goals to be set with regard to the rate and extent of solute removal, a thorough understanding of the mechanisms by which solute removal occurs is necessary. This chapter provides an overview of solute removal by hollow-fiber dialyzers. In the first part of the chapter, the major characteristics of hollow-fiber membranes influencing solute removal are discussed. Within this section, the chemical composition and physical characteristics of commonly used dialysis membranes and the features determining their solute permeability properties are reviewed. The remainder of the chapter emphasizes the major determinants of hollow-fiber dialyzer performance. Copyright (c) 2007 S. Karger AG, Basel
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