Читать книгу Current Perspectives in Kidney Diseases - Группа авторов - Страница 19

Continuous RRT (CRRT) and intermittent hemodialysis (IHD) represent the mainstays of treatment for S-AKI patients requiring RRT. To date, there is no consensus in choosing CRRT or IHD in these patients, but in the presence of hemodynamic instability it is suggested to favor continuous therapies (level 2B in KDIGO guidelines [44]): indeed, hemodynamically unstable patients treated with CRRT remained significantly less dialysis-dependent [51], and CRRT was associated with a trend towards early reduction of vasopressor support [52]. Furthermore, it has been shown that standard IHD has lower capacity to remove several inflammatory cytokines; however, the use of hybrid therapies such as IHD with high cut-off membranes (HCO) or sustained low-efficiency dialysis (SLED) holds some interesting promises. SLED has been shown to provide good tolerability in critically ill patients, excellent clearance of low molecular weight solutes and reasonable clearance of larger molecules able to modulate immune function [53].