Best practice & research. Clinical anaesthesiology
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Protection of renal function and prevention of acute renal failure (ARF) are important goals of resuscitation in critically ill patients. Beyond fluid resuscitation and avoidance of nephrotoxins, little is known about how such prevention can be achieved. Vasoactive drugs are often administered to improve either cardiac output or mean arterial pressure in the hope that renal blood flow will also be improved and, thereby, renal protection achieved. ⋯ In the absence of such data, all that is available is based on limited physiological gains (changes in renal blood flow or urine output) with one or another drug in one or another subpopulation of patients. Furthermore, given our lack of understanding of the pathogenesis of ARF, it is unclear whether haemodynamic manipulation is an appropriate avenue to achieve renal protection. There is a great need for large randomized controlled trials to test the clinical, instead of physiological, effects of vasoactive drugs in critical illness.
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Best Pract Res Clin Anaesthesiol · Mar 2004
ReviewAcid-base balance in acute renal failure and renal replacement therapy.
The approach to acid-base balance based on the concept of strong ions, initially proposed by Stewart, is briefly overviewed. The anion gap and the strong anion gap are both discussed. ⋯ The consequences of renal metabolic acidosis are described. Finally, the impact of renal replacement therapy on acid-base balance is exposed; different modalities of renal replacement are considered in regard to their alkalinizing performance.