Subscribe to RSS
DOI: 10.1055/s-0029-1234005
© Georg Thieme Verlag KG Stuttgart · New York
Dosis der Nierenersatztherapie bei akutem Nierenversagen
Dosage of renal replacement therapy in acute renal injuryPublication History
Publication Date:
25 August 2009 (online)

Summary
Acute kidney injury in the ICU is increasing dramatically worldwide, making the need for renal replacement therapy (RRT) greater than ever. Unresolved issues are questions like when do we start RRT and how do we measure its dose. Several recent trials could show that the relationship between dose of RRT and survival is not a linear one, leaving it to the discretion of the nephrologist and/or intensivist to choose the mean of RRT and its dose in a complex therapeutic concept for the critically ill patient. Highly efficient means of RRT eliminate potentially life-saving drugs like antibiotics to a larger extent than one or two decades ago. As sepsis is responsible for the onset of acute renal failure in more than half of the patients careful adjustment (i. e. increase) of the dose of antibiotics is crucial to avoid under-dosing of these drugs. This holds also true for the nutritional support of these patients as increasing the dose of renal replacement therapy also enhances the elimination of nutrients.
Schlüsselwörter
akutes Nierenversagen - Nierenersatztherapie - Dialysedosis
Keywords
acute kidney injury - renal replacement injury - dialysis frequency
Literatur
- 1
Bouman C S, Van Oudemans-Straaten H M, Tijssen J G, Zandstra D F, Kesecioglu J.
Effects of
early high-volume continuous venovenous hemofiltration on survival
and recovery of renal function in intensive care patients with acute
renal failure: a prospective, randomized trial.
Crit Care
Med.
2002;
30
2205-2211
MissingFormLabel
- 2
Burkhardt O, Hafer C, Langhoff A, Kaever V, Kumar V, Welte T, Haller H, Fliser D, Kielstein J T.
Pharmacokinetics
of ertapenem in critically ill patients with acute renal failure
undergoing extended daily dialysis.
Nephrol Dial Transplant.
2009;
24
267-271
MissingFormLabel
- 3
Centre for Disease Control .
Hospitalization Discharge Diagnoses for Kidney Disease – United
States, 1980 – 2005.
MMWR.
2008;
57
309-312
MissingFormLabel
- 4
Czock D, Husig-Linde C, Langhoff A, Schopke T, Hafer C GK, Swoboda S, Kuse E, Haller H, Fliser D, Keller F, Kielstein J T.
Pharmacokinetics of moxifloxacin and levofloxacin in intensive
care unit patients who have acute renal failure and undergo extended
daily dialysis.
Clin J Am Soc Nephrol.
2006;
1
1263-1268
MissingFormLabel
- 5
Davenport A, Bouman C, Kirpalani A, Skippen P, Tolwani A, Mehta R L, Palevsky P M.
Delivery of renal replacement therapy in acute
kidney injury: what are the key issues?.
Clin J Am Soc
Nephrol.
2008;
3
869-875
MissingFormLabel
- 6
Eloot S, Van Biesen W, Dhondt A, WH, Glorieux G, Verdonck P, Vanholder R.
Impact
of hemodialysis duration on the removal of uremic retention solutes.
Kidney Int.
2008;
73
765-770
MissingFormLabel
- 7
Faulhaber-Walter R, Hafer C, Jahr N, Vahlbruch J, Hoy L, Haller H, Fliser D, Kielstein J T.
The Hannover
Dialysis Outcome study: comparison of standard versus intensified extended
dialysis for treatment of patients with acute kidney injury in the
intensive care unit.
Nephrol Dial Transplant.
2009;
24
2179-2186
MissingFormLabel
- 8
Kielstein J T, Czock D, Schopke T, Hafer C, Bode-Boger S M, Kuse E, Keller F, Fliser D.
Pharmacokinetics and total
elimination of meropenem and vancomycin in intensive care unit patients
undergoing extended daily dialysis.
Crit Care Med.
2006;
34
51-56
MissingFormLabel
- 9
Kielstein J T, Kretschmer U, Ernst T, Hafer C, Bahr M J, Haller H, Fliser D.
Efficacy and cardiovascular tolerability of extended dialysis
in critically ill patients: a randomized controlled study.
Am
J Kidney Dis.
2004;
43
342-349
MissingFormLabel
- 10
Mueller B A, Pasko D A, Sowinski K M.
Higher renal replacement therapy dose delivery influences
on drug therapy.
Artif Organs.
2003;
27
808-814
MissingFormLabel
- 11
Palevsky P M, Zhang J H, O’Connor T Z, Chertow G M, Crowley S T, Choudhury D, Finkel K, Kellum J A, Paganini E, Schein R M, Smith M W, Swanson K M, Thompson B T, Vijayan A, Watnick S, Star R A, Peduzzi P.
Intensity
of renal support in critically ill patients with acute kidney injury.
N Engl J Med.
2008;
359
7-20
MissingFormLabel
- 12
Ratanarat R, Brendolan A, Piccinni P, Dan M, Salvatori G, Ricci Z, Ronco C.
Pulse high-volume haemofiltration for treatment of severe sepsis:
effects on hemodynamics and survival.
Crit Care.
2005;
9
R294-R302
MissingFormLabel
- 13
Roberts J A, Lipman J.
Pharmacokinetic issues
for antibiotics in the critically ill patient.
Crit Care
Med.
2009;
37
840-851
MissingFormLabel
- 14
Ronco C, Bellomo R, Homel P, Brendolan A, Dan M, Piccinni P, La G G.
Effects of different doses in continuous veno-venous haemofiltration
on outcomes of acute renal failure: a prospective randomised trial.
Lancet.
2000;
356
26-30
MissingFormLabel
- 15
Saudan P, Niederberger M, SS, Romand J, Pugin J, Perneger T, Martin P Y.
Adding
a dialysis dose to continuous hemofiltration increases survival
in patients with acute renal failure.
Kidney Int.
2006;
70
1312-1317
MissingFormLabel
- 16
Schiffl H, Lang S M, Fischer R.
Daily hemodialysis and the outcome of acute renal failure.
N Engl J Med.
2002;
346
305-310
MissingFormLabel
- 17
Tolwani A J, Campbell R C, Stofan B S, Lai K R, Oster R A, Wille K M.
Standard versus high-dose CVVHDF for ICU-related acute renal failure.
J Am Soc Nephrol.
2008;
19
1233-1238
MissingFormLabel
- 18
Uchino S, Kellum J A, Bellomo R, Doig G S, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Ronco C.
Acute renal failure in critically ill patients: a multinational,
multicenter study.
JAMA.
2005;
294
813-818
MissingFormLabel
- 19
Vesconi S, Cruz D N, Fumagalli R, Kindgen-Milles D, Monti G, Marinho A, Mariano F, Formica M, Marchesi M, Rene R, Livigni S, Ronco C.
Delivered dose of renal replacement
therapy and mortality in critically ill patients with acute kidney
injury.
Crit Care.
2009;
13
R57
MissingFormLabel
Priv.-Doz. Dr. med. Jan T. Kielstein , FASN
Abteilung Nieren-
und Hochdruckerkrankungen, Medizinische Hochschule Hannover
Carl-Neuberg-Str. 1
30625 Hannover
Phone: 0511/532-6319
Fax: 0511/532-4005
Email: Kielstein@yahoo.com