Book contents
- Frontmatter
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- SECTION 1 Admission to Critical Care
- SECTION 2 General Considerations in Cardiothoracic Critical Care
- SECTION 3 System Management in Cardiothoracic Critical Care
- 3.1 CARDIOVASCULAR SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.2 RESPIRATORY SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.3 RENAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 29 Renal protection and cardiac surgery
- 30 Renal replacement therapy
- 3.4 HAEMATOLGY AND TRANSFUSION IN CARDIOTHORACIC CRITICAL CARE
- 3.5 GASTROINTESTINAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.6 IMMUNE SYSTEM AND INFECTION IN CARDIOTHORACIC CRITICAL CARE
- 3.7 ENDOCRINE SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.8 NEUROLOGICAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- SECTION 4 Procedure-Specific Care in Cardiothoracic Critical Care
- SECTION 5 Discharge and Follow-up From Cardiothoracic Critical Care
- SECTION 6 Structure and Organisation in Cardiothoracic Critical Care
- SECTION 7 Ethics, Legal Issues and Research in Cardiothoracic Critical Care
- Appendix Works Cited
- Index
30 - Renal replacement therapy
from 3.3 - RENAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
Published online by Cambridge University Press: 05 July 2014
- Frontmatter
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- SECTION 1 Admission to Critical Care
- SECTION 2 General Considerations in Cardiothoracic Critical Care
- SECTION 3 System Management in Cardiothoracic Critical Care
- 3.1 CARDIOVASCULAR SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.2 RESPIRATORY SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.3 RENAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 29 Renal protection and cardiac surgery
- 30 Renal replacement therapy
- 3.4 HAEMATOLGY AND TRANSFUSION IN CARDIOTHORACIC CRITICAL CARE
- 3.5 GASTROINTESTINAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.6 IMMUNE SYSTEM AND INFECTION IN CARDIOTHORACIC CRITICAL CARE
- 3.7 ENDOCRINE SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.8 NEUROLOGICAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- SECTION 4 Procedure-Specific Care in Cardiothoracic Critical Care
- SECTION 5 Discharge and Follow-up From Cardiothoracic Critical Care
- SECTION 6 Structure and Organisation in Cardiothoracic Critical Care
- SECTION 7 Ethics, Legal Issues and Research in Cardiothoracic Critical Care
- Appendix Works Cited
- Index
Summary
Introduction
Despite advances in the understanding, diagnosis and treatment of acute renal failure, many aspects remain unresolved. Modern technology has provided different modalities to perform extracorporeal renal support, but it is not clear which is superior in terms of efficacy and outcome. Moreover, evidence-based medicine has not yet defined when to start and when to wean off renal replacement therapy (RRT).
Starting renal replacement therapy
Renal replacement is indicated when renal dysfunction leads to one or more of the following:
• severe fluid overload;
• pulmonary oedema;
• hyperkalemia; and
• metabolic acidosis.
Renal replacement therapy is traditionally considered when all medical treatment (diuretics, bicarbonate administration, fluid restriction and nutritional restriction) have failed. However, greater ease of use and a low associated morbidity has led to RRT being considered earlier in the disease process. This may be related to the perception that maintenance of homeostasis and prevention of complications is increasingly important. There is also some evidence that RRT has some role to play in the management of sepsis and multiple organ dysfunction syndromes, before acute renal failure has ensued. Recent algorithms have placed more emphasis on prevention.
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- Information
- Core Topics in Cardiothoracic Critical Care , pp. 230 - 236Publisher: Cambridge University PressPrint publication year: 2008