Renal Replacement therapy for Septic Patients in Intensive Care Unit

Abstract

Sepsis is defined as an inflammatory response to microorganisms or the invasion of normally sterile host tissue by these organisms. The host inflammatory response in sepsis may lead to multiple organ dysfunction syndrome (MODS) and ultimately death. Acute kidney injury (AKI) is a frequent and serious complication of sepsis in intensive care unit (ICU) patients as part of multiple organ dysfunction syndromes. It further worsens prognosis and increases cost of care. Extracorporeal blood purification techniques can be applied to prevent these complications and improve homeostasis. Renal replacement therapy (RRT) is the mainstay of therapy. Adequacy of dialysis is likely to be linked to better outcome. Various modalities of renal replacement therapy include continuous venovenous hemofiltration, intermittent hemodialysis, and peritoneal dialysis, each with its technical variations but with a common fundamental principle of removing unwanted solutes and water through a semipermeable membrane. The membranes used are either biologic (peritoneum) or artificial (hemodialysis or hemofiltration membranes) and have characteristic advantages and disadvantages. For many years, intermittent hemodialysis (IHD) was the only treatment option for patients with AKI in the ICU. In numerous countries, it is still the most frequently used modality. Continuous venovenous hemofiltration (CVVH) was subsequently proposed as an alternative to IHD in the critically ill, because it was better tolerated by septic patients, the continuous regulation of fluid and nutritional support and also remove mediators of sepsis from circulation.