Giornale italiano di nefrologia : organo ufficiale della Società italiana di nefrologia
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In the last 10-15 years, user-friendly continuous renal replacement therapy (CRRT) machines have played a major role in increasing the popularity of these techniques in intensive care settings. At present it is not clear which modality of renal replacement therapy (RRT) is optimal for critically ill patients with acute kidney injury (AKI). The choice between different modalities should therefore not be based on unproven ''outcome'' advantages but on evaluation of the clinical picture and logistical circumstances. ⋯ Data from several studies comparing the costs of different RRT modalities showed that CRRT is more expensive than IHD or SLED. However, the costs related to SLED can fluctuate within a wide range and in particular settings the higher costs of CRRT could be partially justified by logistical advantages. Further improvements in CRRT device characteristics, anticoagulation protocols, and adaptation of dialysis/replacement fluids to clinical needs will possibly contribute to maintaining, in the coming years, the key role of CRRT in the treatment of hemodynamically unstable critically ill patients requiring RRT.
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Comparative Study
[Continuous vs intermittent renal replacement therapies in acute renal failure: toward an agreement?].
Many studies have addressed the question of renal replacement therapy (RRT) modalities in patients with acute kidney injury (AKI) in the intensive care setting. There is no definite evidence of the superiority of one RRT modality over another. ⋯ The ideal RRT modality for patients with AKI in the ICU probably does not exist, and a more rational approach should be based on the judicious utilization of all the modalities currently available in the ICU, tailoring RRT on the basis of the changing needs of the patients along their clinical course. An important improvement in the approach to RRT in the critical care setting could be the so-called hybrid or prolonged intermittent RRT techniques (e.g., sustained low-efficiency dialysis or SLED), that seem to share most of the advantages of both classical (i.e., short-duration) intermittent and continuous modalities, without their shortcomings.
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Renal replacement therapies (RRT) are a key component of the therapeutic approach to acute kidney injury in the ICU. They are usually performed as intermittent hemodialysis (IHD) or continuous RRT (CRRT). ⋯ The so-called ''hybrid'' therapies have been gaining popularity in recent years. This kind of treatment, known as ''sustained low-efficiency dialysis'' or SLED, has most of the advantages of IHD and CRRT, without sharing their disadvantages and limitations.