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Choice of Peritoneal Dialysis Technique: Intermittent or Continuous

Objectives This chapter will: 1. Describe continuous and intermittent techniques of peritoneal dialysis with their advantages and disadvantages. 2. Discuss the advantages and disadvantages of short dwells. 3. Describe a typical continuous ambulatory peritoneal dialysis schedule. 4. Analyze the experience with high-dose peritoneal dialysis and continuous-flow peritoneal dialysis. Continuous Versus Intermittent Techniques A continuous dialysis therapy represents a period of treatment spanning a full 24-hour period…

Solute and Water Transport Across the Peritoneal Barrier

Objectives This chapter will: 1. Describe the structure of the peritoneal barrier. 2. Review the physiology of solute and water transport under normal conditions. 3. Discuss the effects of the special conditions in the intensive care unit on transperitoneal solute and water transport. Acute kidney injury (AKI) commonly develops in patients in either surgical or medical intensive care units because of these patients' underlying problems. The…

Indications, Contraindications, and Complications of Peritoneal Dialysis in Acute Renal Failure

Objectives This chapter will: 1. Present data on the clinical effectiveness of peritoneal dialysis (PD) in treatment of acute renal failure. 2. Compare clinical benefits of acute PD with those of other modalities of dialysis for support of patients with acute renal failure. 3. Explain some particular benefits of PD, especially in removal of middle-molecular-weight toxins, protein-bound toxins, and fluid. 4. Detail the clearance benefits of…

Peritoneal Dialysis System

Objectives This chapter will: 1. Describe the anatomic characteristics of the peritoneal dialysis system. 2. Discuss peritoneal microcirculation. 3. Explain the mesothelial membrane. 4. Discuss the dialysate compartment and the influence of different dialysate flow/dwell times on efficacy of treatment. Several factors affect the delivery of therapy in peritoneal dialysis. They are the amount of fluid used, the frequency of exchanges, the dwell time, and the…

Nomenclature: Techniques

Objectives This chapter will: 1. List the nomenclature related to extracorporeal renal replacement therapies. 2. Provide a detailed description of the main components and procedures of a treatment. 3. Define and characterize main extracorporeal therapies and techniques. This chapter reports the conclusions of a consensus expert conference on the nomenclature of renal replacement therapy (RRT) techniques currently used to manage acute kidney injury (AKI) and other…

Nomenclature: Basic Principles

Objectives This chapter will: 1. List the nomenclature related to extracorporeal renal replacement therapies. 2. Provide a detailed description of the performance characteristics of membranes and filters. 3. Define and characterize transmembrane transport of solutes and fluid. 4. Name methods of measurement of prescribed and delivered treatment. This chapter reports the conclusions of a consensus expert conference on the basic principles and nomenclature of renal replacement…

Antibiotic Adjustment in Continuous Renal Replacement Therapy

Objectives This chapter will: 1. Summarize the major pharmacokinetic, pharmacodynamic, and physicochemical properties of antibiotics. 2. Discuss the impact of critical illness or impaired renal function on the pharmacokinetics of antibiotics. 3. Explain how continuous renal replacement therapy can affect the pharmacokinetic/pharmacodynamic relationship of the antimicrobial drugs. 4. Present the rationale for individualized dosage adjustment of antibiotics during renal replacement therapy. Basic Pharmacologic Parameters of Antimicrobial…

Clinical Effects of Continuous Renal Replacement Therapies

Objectives This chapter will: 1. Describe different renal replacement strategies and their clinical effects on critically ill patients. 2. Review the benefits and side effects of continuous renal replacement therapies. 3. Compare the clinical effects of continuous therapies with those of intermittent and hybrid techniques. Different renal replacement therapy (RRT) modalities and prescriptions will result in various clinical effects in individual critically ill patients. These effects…

High Cutoff Membranes for Mediators Removal

Objectives This chapter will: 1. Illustrate the engineering characteristics of high cutoff membranes. 2. Review the recent literature dealing the clearance effects of high cutoff membranes on large molecules. 3. Provide some practical suggestions on bedside management of septic patients treated with high cutoff membranes. Cytokines are middle molecular weight molecules having autocrine, paracrine, and/or endocrine effects. These molecules regulate the hormonal, metabolic, and immunologic responses…

Pulse High-Volume Hemofiltration in Management of Critically Ill Patients With Severe Sepsis or Septic Shock

Objectives This chapter will: 1. Assess the safety, feasibility, and technical considerations with use of pulse high-volume hemofiltration as an adjuvant therapy for critically ill patients with sepsis or septic shock. 2. Review the rationale for the use of pulse high-volume hemofiltration in this clinical setting. 3. Evaluate the current clinical and experimental evidence supporting the use of pulse high-volume hemofiltration as an adjuvant therapy for…

High-Volume Hemofiltration in the Intensive Care Unit

Objectives This chapter will: 1. Explain the rationale to use high-volume hemofiltration in the intensive care setting. 2. Provide the latest definition of high-volume hemofiltration. 3. Describe the related studies performed in the last 15 years and the recommendations based on the latest randomized controlled trials. High-volume hemofiltration (HVHF) still is used in the intensive care unit (ICU) for various pathologies despite some recent negative randomized…

Adequacy of Continuous Renal Replacement Therapy: Prescription and Delivery

Objectives This chapter will: 1. Help the reader understand the concept of clearance and the manner in which it is applied to estimate dose of renal replacement therapy. 2. Describe the differences in the use of urea kinetic modeling (UKM) for end-stage renal disease and acute kidney injury. 3. Help the reader understand the important studies that have employed urea kinetic approaches to quantify the dose…

Nursing Strategies to Prevent Coagulation of the Extracorporeal Circuit

Objectives This chapter will: 1. Emphasize that clotting in the continuous renal replacement therapy circuit is complex and affected by many factors in the critically ill patient. 2. Explain that anticoagulant agents can prevent or delay clotting but are not the only preventive strategy necessary. 3. Indicate that clotting occurs in either the membrane or the venous air trap chamber and propose how this clot may…

Anticoagulation Strategies for Continuous Renal Replacement Therapy

Objectives This chapter will: 1. Describe nonanticoagulant measures to promote circuit patency. 2. Identify the ideal anticoagulant for continuous renal replacement therapy. 3. Describe the advantages and risks of the most commonly used anticoagulant strategies. 4. Provide basic recommendations for the use of these anticoagulants for continuous renal replacement therapy depending on the clinical situation. Critically ill patients receiving continuous renal replacement therapy (CRRT) for acute…

Vascular Access for Acute Renal Replacement Therapy

Objectives This chapter will: 1. Review central venous catheter as the vascular access standard reference for renal replacement therapy in acute kidney failure (stage 3 acute kidney injury). 2. Describe the two main categories of central venous catheters: short-term or acute, made of semirigid polymer (polyurethane, carbothane) and bearing usually two lumens, and long-term tunneled or chronic, made of soft polymer (silicone, polyurethane) and bearing two…

Continuous Renal Replacement Therapy: Modalities and Their Selection

Objectives This chapter will: 1. Review the principles of continuous renal replacement therapy. 2. Discuss the practical application of continuous renal replacement therapy and the consequences of such application. 3. Examine the consequences of technical modifications to continuous renal replacement therapy. 4. Provide information pertaining to choices and prescription of continuous renal replacement therapy. Endogenous toxins accumulate in blood as a result of many biochemical processes.…

Solute and Water Kinetics in Continuous Therapies

Objectives This chapter will: 1. Describe the basic mechanisms of fluid transport and solute removal (ultrafiltration, diffusion, convection, and adsorption) and the factors influencing these processes in continuous renal replacement therapy. 2. Describe the manner in which the basic principles of solute and water removal apply in the clinical application of the different continuous renal replacement therapy modalities. 3. Apply the above principles in relation to…

Beginning and Ending Continuous Renal Replacement Therapy in the Intensive Care Unit

Objectives This chapter will: 1. Discuss the definitions of early versus delayed initiation of continuous renal replacement therapy. 2. Discuss the rationale of early versus delayed initiation of continuous renal replacement therapy. 3. Present the evidence for the timing of initiation of continuous renal replacement therapy, including data from recent randomized trials. 4. Present the evidence for the ending of continuous renal replacement therapy and clinical…

Indications for Continuous Renal Replacement Therapy: Renal Replacement Versus Renal Support

Objectives This chapter will: 1. Explain and describe the main clinical indications for starting continuous renal replacement therapy (CRRT). 2. Consider renal and nonrenal indications of CRRT. 3. Provide theoretical support for the early application of CRRT to control fluid overload, remove solutes, and improve patient survival. 4. Illustrate some nonrenal indications for the use of CRRT and to review recent literature about the new CRRT…

Nursing Issues and Procedures in Continuous Renal Replacement Therapy

Objectives This chapter will: 1. Discuss and suggest suitable nursing lectures, tutorials, and a practical pathway for continuous renal replacement therapy (CRRT) nursing knowledge and competency. 2. Describe the suitable items and content for policy and documents used to manage CRRT. 3. Highlight the importance of the anticoagulation section in the policy. 4. Describe suitable CRRT machine attributes and their improved functionality. 5. Outline the importance…