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Chapter 38 - Renal replacement therapy

from Section III: - Organ dysfunction and management

Published online by Cambridge University Press:  06 July 2010

Edited by
Edited in association with
Fang Gao Smith
Affiliation:
University of Warwick
Joyce Yeung
Affiliation:
West Midlands Deanery
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Summary

Renal replacement therapy (RRT) is utilized when medical management of renal dysfunction has failed to prevent the development of established renal failure. The chapter lists out commonly used triggers for commencing RRT. The different modes of renal replacement therapy are: slow continuous ultrafiltration, continuous veno-venous haemofiltration, continuous veno-venous haemodialysis and continuous veno-venous haemodiafiltration. During haemofiltration, fluid removed by ultrafiltration must be replaced prior to delivery back to the patient. The exact volume of replacement fluid may be altered to produce the overall fluid balance required. Blood clot formation increases blood transfusion requirements due to blood loss within the discarded system. For these reasons anticoagulation is standard. The current concept of an extracorporeal RRT machine diversifies into a multi-organ support therapy (MOST) machine. The variations on RRT may be used to facilitate plasmapheresis, immunomodulation or influence other organ dysfunction.
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Publisher: Cambridge University Press
Print publication year: 2010

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