Kidney international. Supplement
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The evolution of technology and biomaterials has permitted a parallel development of renal replacement therapies in the acute, critically ill patient. From the original description of continuous arteriovenous hemofiltration (CAVH), new techniques such as continuous venous venous hemofiltration (CVVH), hemodiafiltration (HDF) and high flux dialysis (HFD) have been developed and clinically utilized. ⋯ In this field, recent observations have suggested the use of hemofiltration with high volumes of fluid exchange. The hardware and software of the newer continuous renal replacement therapy (CRRT) systems are certainly the key points in achieving these results and in safely performing such challenging techniques.
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Several factors combine to facilitate the evolution towards heart and multi-organ failure following cardiac surgery. Some of these factors are related to pure cardiac aspects, for example, the existence of a preoperative heart disease, the use of aortic cross clamping or performance of cardiotomy. Cardiopulmonary bypass (CPB) also plays an important role in the occurrence of postoperative organ dysfunctions by two principal means. ⋯ Initially hemofiltration was intended to correct the accumulation of extravascular water during or immediately following the surgical procedure. Nevertheless, several of its side-effects appeared to be useful, such as the reduction of postoperative blood loss and immediate improvement in hemodynamics. Several studies attempted to point out the mechanism of action of hemofiltration and although removal of inflammatory mediator occurs, there is currently no proof that this removal is the actual mechanism by which this technique acts.
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Review Comparative Study
Continuous versus intermittent renal replacement therapy in the intensive care unit.