Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · May 2015
Review Comparative Study[Acute kidney injury: choice of the initial modality for renal replacement therapy].
Continuous and intermittent renal replacement therapies are thought to be equally adequate approaches for the treatment of patients with acute kidney injury. Accordingly, current guidelines advocate the use of different modalities in a complementary fashion, i.e., to tailor therapy to the specific clinical situation. ⋯ Intermittent hemodialysis, on the other hand, remains the therapy of choice for the rapid correction of life-threatening electrolyte abnormalities or metabolic acidosis. During the further course of treatment, an individualized approach should be continued which may include a switch between modalities based on current therapeutic goals and potential risks for side effects of renal replacement therapy.
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The activation of multiple pro- and anti-inflammatory mediators is a key feature in the pathophysiology of sepsis. Many of these mediators may directly contribute to organ dysfunction and determine disease severity. So far our ability to modulate these upregulated mediator pathways is very limited. Therefore the adsorption of such mediators via an extracorporeal circuit may be a beneficial intervention during sepsis. ⋯ Whilst biochemical efficacy could be demonstrated by some of the systems, controlled and randomized studies demonstrating improved clinical endpoints are still lacking. Therefore the use of such therapies outside clinical studies cannot yet be recommended.