Ronco C, Bellomo R
Department of Nephrology, St. Bortolo Hospital, Vicenza, Italy.
Kidney Int Suppl. 1998 May;66:S160-4.
The evolution of technology and biomaterials has permitted a parallel development of renal replacement therapies in the acute, critically ill patient. From the original description of continuous arteriovenous hemofiltration (CAVH), new techniques such as continuous venous venous hemofiltration (CVVH), hemodiafiltration (HDF) and high flux dialysis (HFD) have been developed and clinically utilized. A parallel improvement in efficiency has been achieved with daily clearances of urea as high as 50 liters or more. The use of special highly permeable dialyzers has also permitted increases in the clearances of larger solutes, thus leading to significant removals of chemical substances involved the acute inflammation and sepsis. In this field, recent observations have suggested the use of hemofiltration with high volumes of fluid exchange. The hardware and software of the newer continuous renal replacement therapy (CRRT) systems are certainly the key points in achieving these results and in safely performing such challenging techniques.
技术和生物材料的发展使得针对急性危重症患者的肾脏替代疗法得以同步发展。从最初的持续动静脉血液滤过（CAVH）描述开始，诸如持续静脉-静脉血液滤过（CVVH）、血液透析滤过（HDF）和高通量透析（HFD）等新技术已得到开发并在临床中应用。随着每日尿素清除率高达50升或更高，效率也得到了相应提高。使用特殊的高通透性透析器还能增加大分子溶质的清除率，从而显著清除与急性炎症和脓毒症相关的化学物质。在该领域，最近的观察结果表明可采用大量液体交换的血液滤过。更新的连续性肾脏替代治疗（CRRT）系统的硬件和软件无疑是实现这些结果以及安全实施此类具有挑战性技术的关键所在。
