Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
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Acute renal failure (ARF) is often a component of multiple organ system failure in critically ill patients. Sepsis (i.e. systemic bacterial infection) is a major factor in the aetiology of ARF and this is primarily caused by sepsis-induced cardiovascular and pulmonary failure. ⋯ However, ARF in the course of sepsis or endotoxaemia may not be solely due systemic or renal haemodynamic changes, since humoral and cellular reactions may also have an adverse effect on renal function. This review will address the haemodynamic and non-haemodynamic factors and their interaction in the development of ARF during sepsis.
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Nephrol. Dial. Transplant. · Jan 1993
Acid-base responses to high-volume haemofiltration in the critically ill.
We have studied the acid-base and cardiorespiratory effects of intermittent pumped high-volume venovenous haemofiltration (HVHF) using replacement fluid containing lactate as the source of bicarbonate in critically ill patients. We demonstrated significant hyperlactataemia throughout the procedure, but there was no deterioration in acid-base status, haemodynamics, or oxygen delivery. These observations suggest that the worsening of acidosis and the hypotension that have been described with this technique can be avoided by appropriate monitoring and resuscitation prior to haemofiltration, and may be due to unrecognized inadequacies in the oxygen transport system.