HARD DECISIONS IN INTENSIVE CARE UNIT

Intensivecareunitkapak

HEMODIALYSIS

Mete Erdemir

Gülhane Training and Research Hospital, Department of Intensive Care, Ankara, Türkiye

Erdemir M. Hemodialysis. In: Turan S, editor. Hard Decisions in Intensive Care Unit. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.61-69.

ABSTRACT

Hemodialysis is the process of removing solutes in the blood by diffusion according to the concen tration gradient (from more dense to a less dense environment). Hemodialysis can be administered as conventional, prolonged intermittent and continuous renal replacement therapy. There is still no tangible difference between continuous renal replacement therapy (CRRT), prolonged intermittent re nal replacement therapy (PIRRT) and intermittent hemodialysis (IHD) in terms of survival and acute kidney injury treatment. In lifethreatening electrolyte and acidbase disorders, drug intoxications and poisoning with dialyzable substances, IHD is preferred more frequently than other hemodialysis mo dalities because of its rapid solute removal. In addition, the short treatment duration is beneficial in terms of rehabilitation, mobilization and other medical procedures required for patients. Hemodynamic instability is the most important limitation of IHD use in patients being followed in the intensive care unit. IHD treatment in hemodynamically stable patients is a rapid, effective and lowcost method. IHD treatment, which is a rapid and effective treatment method, should be preferred in cases of intoxica tions, situations which anticoagulant use is contraindicated, ovedose use of drugs, severe electrolyte and acidbase disorders.

Keywords: Acute kidney injury; Renal dialysis; Critical care; Anticoagulants; Renal replacement

terapy

Referanslar

  1. Sharma N, Khav E, Elahmadi A, Ong J, Parag S. Dr. Willem Kolff: The Father of the Artificial Kidney. Cureus. 2024;16(9):e69098. [Crossref]
  2. Ainsworth CR, Chung KK. Renal replacement therapy: A practical approach. Surgical Critical Care Therapy: A Clinically Oriented Practical Approach. Surgical Critical Care Therapy. Springer, Cham. 2018: 289-299. [Crossref]
  3. Patel PP, Egodage T. Failing kidneys: renal replacement therapies in the ICU. Trauma Surgery & Acute Care Open. 2024;2(9):e001381. [Crossref]  [PubMed]  [PMC]
  4. Zarbock A, Kellum JA, Schmidt C, Van Aken H, Wempe C, Pavenstädt H, et al. Effect of early vs delayed initiation of renal replacement therapy on mortality in critically ill patients with acute kidney injury: the ELAIN randomized clinical trial. JAMA. 2016;315(20):2190-9. [Crossref]  [PubMed]
  5. Gaudry S, Hajage D, Schortgen F, Martin-Lefevre L, Pons B, Boulet E, et al. Initiation strategies for renal-replacement therapy in the intensive care unit. N Engl J Med. 2016;375(2):122-133. [Crossref]  [PubMed]
  6. Barbar SD, Clere-Jehl R, Bourredjem A, et al. Timing of Renal-Replacement Therapy in Patients with Acute Kidney Injury and Sepsis. N Engl J Med. 2018;379(15):1431-1442. [Crossref]  [PubMed]
  7. Gaudry S, Palevsky PM, Dreyfuss D. Extracorporeal kidney-replacement therapy for acute kidney injury. New England Journal of Medicine. 2022;386:964-975. [Crossref]  [PubMed]
  8. Daugirdas JT, Depner TA, Inrig J, Mehrotra R, Rocco MV, Suri RS, et al. KDOQI clinical practice guideline for hemodialysis adequacy: 2015 update. American journal of kidney diseases. 2015; 66(5): 884-930. [Crossref]  [PubMed]
  9. Nash DM, Przech S, Wald R, O'Reilly D. Systematic review and meta-analysis of renal replacement therapy modalities for acute kidney injury in the intensive care unit. J Crit Care. 2017 Oct;41:138-144. [Crossref]  [PubMed]
  10. Kellum JA, Lameire N, Aspelin P, Barsoum RS, Burdmann, EA, Goldstein SL, et al. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney international supplements, 2012;2(1):1-138. [Link]
  11. Lorente L, Henry C, Martín MM, Jiménez A, Mora ML. Central venous catheter related infection in a prospective and observational study of 2,595 catheters. Critical care, 2005;9(6):1-5. [Link]
  12. Oliver MJ. Acute dialysis catheters. Semin Dial. 2001;14(6): 432-435. [Crossref]  [PubMed]
  13. Parienti JJ, Thirion M, Mégarbane B, et al. Femoral vs jugular venous catheterization and risk of nosocomial events in adults requiring acute renal replacement therapy: a randomized controlled trial. JAMA. 2008;299(20):2413-2422. [Crossref]  [PubMed]
  14. Parienti JJ, Mégarbane B, Fischer MO, et al. Catheter dysfunction and dialysis performance according to vascular access among 736 critically ill adults requiring renal replacement therapy: a randomized controlled study. Crit Care Med. 2010;38(4):1118-1125. [Crossref]  [PubMed]
  15. Mrozek N, Lautrette A, Timsit JF, Souweine B. How to deal with dialysis catheters in the ICU setting. Annals of Intensive Care. 2012;2(48):1-13. [Crossref]  [PubMed]  [PMC]
  16. Morgan D, Ho K, Murray C, Davies H, Louw J. A randomized trial of catheters of different lengths to achieve right atrium versus superior vena cava placement for continuous renal replacement therapy. American journal of kidney diseases. 2012;60(2):272-279. [Crossref]  [PubMed]
  17. Gallieni M, Giordano A, Rossi U, Cariati M. Optimization of dialysis catheter function. The Journal of Vascular Access. 2016;17(1):42-46. [Crossref]  [PubMed]
  18. Rachoin JS, Weisberg LS. Renal replacement therapy in the ICU. Critical care medicine. 2019;47(5):715-721. [Crossref]  [PubMed]
  19. Chan RJ, Helmezci W, Canney M, Clark EG. Management of intermittent hemodialysis in the critically ill patient. Clinical Journal of American Society of Nephrology. 2023;18(2):245-255. [Crossref]  [PubMed]  [PMC]
  20. Vijayan A, Santos RBD, Li T, Goss CW, Palevsky PM. Effect of frequent dialysis on renal recovery: results from the acute renal failure trial network study. Kidney International Reports. 2018;3(2):456-463. [Crossref]  [PubMed]  [PMC]
  21. Schiffl H, Lang S. M, Fischer R. Daily hemodialysis and the outcome of acute renal failure. New England Journal of Medicine. 2002;346(5):305-310. [Crossref]  [PubMed]
  22. Palevsky PM, Zhang JH, O'Connor TZ, Chertow GM, Crowley ST, Choudhury D, et al. İntensity of renal support in critically ill patients with acute kidney injury. New England Journal of Medicine 2008; 359(1):7-20. [Crossref]  [PubMed]  [PMC]
  23. Parienti JJ, Mongardon N, Mégarbane B, Mira JP, Kalfon P, Gros A. Intravascular complications of central venous catheterization by insertion site. New England Journal of Medicine. 2015;373(13):1220-1229. [Crossref]  [PubMed]
  24. Basile C, Davenport A, Mitra S, Pal A, Stamatialis D, Chrysochou C, et al. Frontiers in hemodialysis: Innovations and technological advances. Artificial organs. 2021;45(2):1-8. [Crossref]  [PubMed]
  25. Bagshaw SM, Darmon M, Ostermann M, et al. Current state of the art for renal replacement therapy in critically ill patients with acute kidney injury. Intensive Care Med. 2017;43(6):841-854. [Crossref]  [PubMed]
  26. Davenport A. Low-molecular-weight heparin as an alternative anticoagulant to unfractionated heparin for routine outpatient haemodialysis treatments. Nephrology. 2009;14(5): 455-461. [Link]
  27. Himmelfarb J. Hemodialysis complications. American journal of kidney diseases. 2005;45(6):1122-1131. [Crossref]  [PubMed]