Nierenersatztherapie in der Intensivmedizin

Acute renal failure (ARF) can be treated since the end of the 1970s either by continuous forms of extracorporeal treatment (CRRT) or by intermittent dialysis (IHD). There is no difference in the mortality comparing CRRT and IHD neither in meta-analyses nor in prospective randomized trials. There are a few critically ill patients, especially those with severe sepsis and septic shock who should only be treated by CRRT. Every form of treatment should be started early as it is necessary to avoid further damage of other vital function disorders due to the loss of exocrine renal function. Independent of the treatment form all critically ill patients need a dosage of dialysis enabling control over the negative effects of the hypercatabolic situation in these patients. An increase of the dosage above the minimal requirements did not lead to a better survival rate in this inhomogenous group of patients. In continuous forms of treatment an exchange amount of 20?ml/kg body weight/h should be achieved and for intermittent dialysis a minimal Kt/V of 4?C4.5 per week is necessary. Fluid balancing often leads to the necessity of daily dialysis in the intensive care unit.