Author/Editor     Buturović-Ponikvar, Jadranka
Title     Dializno zdravljenje akutne ledvične odpovedi
Translated title     Acute renal failure requiring dialysis treatment
Type     članek
Source     Med Razgl
Vol. and No.     Letnik 41, št. Suppl 3
Publication year     2002
Volume     str. 37-43
Language     slo
Abstract     Acute renal failure requiring dialysis mainly occurs as a part of multiorgan failure in critically ill patients within intensive care units. Mortality of these patients remains high, between 50 and 90%, despite significant improvement in technology. Standard renal replacement therapy for critically ill adult patients with acute renal failure is intermittent hemodialysis, usually performed more frequently than in patients requiring chronic hemodialysis. Alternative treatment is continuous dialysis (24-hours daily) with different modalities. The main advantage of continuous over intermittent treatment is better fluid balance and better circulatory stability. However, direct comparison of both treatments failed to show survival benefit in patients treated continuously. On the other hand, daily intermittent dialysis was shown to improve survival compared to every-other-day dialysis. Intermittent and continuous dialysis can be combined in particular patient during the course of acute renal failure. For optimal outcome and rational therapy an individual prescription of dialysis for each critically ill patient is preferred, in close collaboration of intensivist and nephrologist.
Summary     Akutna ledvična odpoved, ki jo zdravimo z dializo, se večinoma pojavlja v sklopu večorganske odpovedi pri kritično bolnih v intenzivnih enotah. Umrljivost teh bolnikov je, kljub napredku tehnologije, še vedno zelo visoka, med 50 in 90%. Standardno dializno zdravljenje pri kritično bolnih odraslih z akutno ledvično odpovedjo je intermitentna hemodializa, ki jo običajno izvajamo pogosteje kot pri kroničnih hemodializnih bolnikih. Alternativno zdravljenje je neprekinjena (kontinuirna) dializa (24-urna) in njene različice. Osnovna prednost kontinuiranih metod pred intermitentnimi je boljše vodenje tekočinske bilance in boljša srčno-žilna stabilnost. Kljub temu pa direktna primerjava obeh metod ni pokazala boljšega preživetja pri bolnikih, zdravljenih kontinuirno. Izboljšanje preživetja bolnikov so pa dosegli z vsakodnevno hemodializo, če primerjamo s hemodializo vsak drug dan. Obe metodi (intermitentno in kontinuirno) pa lahko kombiniramo pri istem bolniku med zdravljenjem akutne ledvične odpovedi. Za maksimalno uspešno in racionalno zdravljenje je zaželjeno posameznemu bolniku prilagojeno predpisovanje dialize, v tesnem sodelovanju intenzivista in nefrologa.
Descriptors     KIDNEY FAILURE, ACUTE
HEMODIALYSIS
HEMOFILTRATION
INTENSIVE CARE UNITS