ISSN: 1305-385X
Hakkında: Özel sayılar şeklinde yayınlanır.
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Alternative Dialysis Treatments
Dr. Ayşe BİLGİÇ,a Dr. F. Nurhan ÖZDEMİRa
aNefroloji BD, Başkent Üniversitesi Tıp Fakültesi, ANKARA
The therapies entitled “Alternative Dialysis Treatments” includes “Continuous Renal Replacement Therapy (CRRT)”, “Plasmapheresis” and “Hemoperfusion”. CRRT is an alternative dialysis treatment which involves application of lower solute clearances and ultrafiltration rates (UFR). Acute renal failure is a common complication in critically ill patients; nearly 70% of patients require RRT and CRRT to complement or supplant intermittent HD. CRRT provides better hemodynamic stability by lower UFR and better azotemia control even in severely catabolic patients. An additional advantage may be more effective immunomodulatory substance removal, such as endotoxin and cytokines. However, CRRT interruptions due to circuit clotting and out-of-unit procedures lead to dialysis dose reduction and blood circuitry change related cost increase. CRRT modalities are classified according to vascular accesses and mechanisms of solute removal. All types of CRRT use highly permeable membranes to water and low-molecular-weight solutes.
Plasmapheresis is often employed to rapidly lower circulating titers of autoantibodies (antiglomerular basement membrane disease) or immune complexes (lupus nephritis). Other beneficial effects on immune function include depletion of complement products, fibrinogen, and some cytokines, alterations in antibody balance, and improvement in reticuloendothelial system function.
Hemoperfusion is a treatment method which refers to the passage of blood through a column containing sorbent particles. Principle of hemoperfusion relies on drug adsorption. When compared with HD, peritoneal dialysis, or forced diuresis, drug removal is much better with hemoperfusion. Thus, hemoperfusion is an effective extracorporeal treatment method for drug over-dose.Keywords: Continue renal replacement treatment, plasmapheresis, hemoperfusion, acute renal failureTurkiye Klinikleri J Int Med Sci 2006, 2(4):97-104
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