Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Department of Critical Care Medicine, Center for Critical Care Nephrology, The CRISMA Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Semin Dial. 2021 Nov;34(6):567-575. doi: 10.1111/sdi.12975. Epub 2021 May 6.
Continuous renal replacement therapy (CRRT) has become a mainstay therapy in the intensive care unit (ICU) and its utilization continues to increase in developed countries. The wide variations of CRRT practice, however, are evident in developing countries while clinicians in these resource-limited countries encounter various barriers such as a limited number of nephrologists and trained staff, a gap of knowledge, machine unavailability, cultural and socioeconomic aspects, high-cost therapy without reimbursement, and administrative as well as governmental barriers. In this article, we demonstrate the situation of CRRT and discuss the barriers of CRRT in a resource-limited setting. We also discuss the strategies to improve CRRT practice. These recommendations can serve as a fundamental guideline for clinicians to implement CRRT in low-resource settings.
连续肾脏替代治疗(CRRT)已成为重症监护病房(ICU)的主要治疗方法,在发达国家的应用也在不断增加。然而,在发展中国家,CRRT 的实践存在广泛差异,而这些资源有限的国家的临床医生面临着各种障碍,如肾科医生和训练有素的工作人员数量有限、知识差距、机器不可用、文化和社会经济方面、高成本治疗而无补偿以及行政和政府方面的障碍。在本文中,我们展示了 CRRT 的情况,并讨论了资源有限环境下 CRRT 的障碍。我们还讨论了改善 CRRT 实践的策略。这些建议可以作为临床医生在资源有限的环境中实施 CRRT 的基本指南。