CONTINUOUS RENAL REPLACEMENT THERAPY (CRRT)
Dr. Manish Chaturvedi Nephrologist, Dr. S. N. Medical College, Jodhpur
The Indian Anaesthetists’ Forum – (www.theiaforum.org) Online ISSN 0973-0311 October 2004
It is a mode of renal replacement therapy for hemodynamically unstable, fluid overloaded, catabolic septic patients and finds its application in management of acute renal failure especially in the critical care /intensive care unit setting. The popularity of ‘slow continuous therapies’ for the treatment of critically ill patients with renal failure is increasing. The techniques most commonly used are slow continuous hemodialysis and hemodiafiltration. Slow continuous hemofiltration and slow continuous ultrafiltration also are commonly used.
ARF in the ICU setting is frequent especially secondary to multiple organ dysfunction syndrome; post surgical setting i.e after abdominal surgery; post interventional studies eg. PTCA, PTRA studies in already susceptible individuals. These patients having various co-morbid conditions are on mechanical ventilation and various life supporting modalities which do not merit the dialysis procedure to be carried out in the routine dialysis set up.
Being catabolic, they require continuous clearance of waste produced due to ongoing illnesses and an adequate potential for infusion of nutritional and inotropic agents for sustenance of vital parameters which is continuously desired in the management. CRRT has tried to meet these challenges in the ICU settings since its inception and has saved many lives across the globe including critically ill paediatric or geriatric population with renal failure as a co-existent co-morbid illness.
The outcome of therapy depends on clearance of waste products achieved with restoration of blood biochemistry; maintenance of fluid, electrolyte and acid base balance; ability to maintain hemodynamic stability during the procedure with minimum side effects during the procedure.
GOALS OF CRRT THERAPY
The aggressive management in initial hours to counter the derangements in critically ill patients is the cornerstone in the therapy. CRRT initiated for ARF in critically ill patients should serve as a renal ‘replacement’ therapy mimicking as artificial kidney support. It should enhance recovery of the native kidneys with prevention of hyperkalemia, hyper/hyponatremia, acidosis/alkalosis and rapid correction of pulmonary/peripheral edema by gradual and consistent removal of surplus fluid retained in the body. It should also diffuse the various ongoing smoldering proinflammatory mediators especially in multiple organ dysfunction syndromes.
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