Continuous renal replacement therapy (CRRT) in the intensive care unit (ICU) is a common treatment in acute renal failure. CRRT is mainly conceived as merely supportive and as a replacement of the lost kidney function. On the other hand, evidence accumulated over recent years demonstrates that many soluble mediators of the systemic inflammatory (and anti-inflammatory) response syndrome (SIRS) can be removed by CRRT. This has led to the suggestion that CRRT could play a major role in sepsis therapy as an immunomodulatory treatment and not only as a blood purification technique. In this perspective, whereas animal studies yielded encouraging results, early clinical trials showed only minor clinical benefits, mainly dealing with hemodynamic improvements. The question of treatment dose has appropriately been raised as it remains undefined and a matter of controversy. A large-scale clinical trial has clarified issues on treatment dose in acute renal failure but a sufficiently powered study on hemofiltration dose in sepsis is still lacking.
KeywordsSeptic Shock Continuous Renal Replacement Therapy Ethyl Pyruvate Ultrafiltration Rate Continuous Venovenous Hemofiltration
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