{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T18:16:43Z","timestamp":1791829003338,"version":"4.3.4"},"reference-count":122,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[1998,3,1]],"date-time":"1998-03-01T00:00:00Z","timestamp":888710400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Ann Pharmacother"],"published-print":{"date-parts":[[1998,3]]},"abstract":"\n OBJECTIVE:<\/jats:title>\n To characterize the multiple continuous renal replacement therapy (CRRT) techniques available for the management of critically ill adults, and to review the indications for and complications of use, principles of drug removal during CRRT, drug dosage individualization guidelines, and the influence of CRRT on patient outcomes.<\/jats:p>\n <\/jats:sec>\n \n DATA SOURCES:<\/jats:title>\n MEDLINE (January 1981\u2013December 1996) was searched for appropriate publications by using terms such as hemofiltration, ultrafiltration, hemodialysis, hemodiafiltration, medications, and pharmacokinetics; selected articles were cross-referenced.<\/jats:p>\n <\/jats:sec>\n \n STUDY SELECTION:<\/jats:title>\n References selected were those considered to enhance the reader's knowledge of the principles of CRRT, and to provide adequate therapies on drug disposition.<\/jats:p>\n <\/jats:sec>\n \n DATA SYNTHESIS:<\/jats:title>\n CRRTs use filtration\/convection and in some cases diffusion to treat hemodynamically unstable patients with fluid overload and\/or acute renal failure. Recent data suggest that positive outcomes may also be attained in patients with other medical conditions such as septic shock, multiple organ dysfunction syndrome, and hepatic failure. Age, ventilator support, inotropic support, reduced urine volume, and elevated serum bilirubin concentrations have been associated with poor outcomes. Complications associated with CRRT include bleeding due to excessive anticoagulation and line disconnections, fluid and electrolyte imbalance, and filter and venous clotting. CRRT can complicate the medication regimens of patients for whom it is important to maintain drug plasma concentrations within a narrow therapeutic range. Since the physicochemical characteristics of a drug and procedure-specific factors can alter drug removal, a thorough assessment of all factors needs to be considered before dosage regimens are revised. In addition, an algorithm for drug dosing considerations based on drug and CRRT characteristics, as well as standard pharmacokinetic equations, is proposed.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n The use of CRRT has expanded to encompass the treatment of disease states other than just acute renal failure. Since there is great variability among treatment centers, it is premature to conclude that there is enhanced survival in CRRT-treated patients compared with those who received conventional hemodialysis. This primer may help clinicians understand the need to individualize these therapies and to prospectively optimize the pharmacotherapy of their patients receiving CRRT.<\/jats:p>\n <\/jats:sec>\n \n OBJETIVO:<\/jats:title>\n Caracterizar las m\u00faltiples t\u00e9cnicas de reemplazo renal continuo (TRRC) disponibles para el manejo de pacientes adultos en estado cr\u00edtico. Examinar las indicaciones de uso y complicaciones de cada t\u00e9cnica de TRRC, los principios de remoci\u00f3n de medicamentos durante TRRC, gu\u00edas para individualizar la posologia, y la influenc\u00eda de TRRC en los resultados cl\u00ednicos obtenidos.<\/jats:p>\n <\/jats:sec>\n \n FUENTES DE INFORMACI\u00d3N:<\/jats:title>\n Se hizo una b\u00fasqueda en el sistema de inform\u00e1tica MEDLINE en los a\u00f1os 1980\u20131996 incluyendo t\u00e9rminos como hemofiltraci\u00f3n, ultrafiltraci\u00f3n, hemodialisis, hemodiafiltraci\u00f3n, medicamentos, y farmacocin\u00e9tica. Adem\u00e1s se buscaron articulos adicionales utilizando las referencias de los dem\u00e1s articulos selecionados.<\/jats:p>\n <\/jats:sec>\n \n SELECCI\u00d3N DE FUENTES DE INFORMACI\u00d3N:<\/jats:title>\n La referencias seleccionadas fueron aquellas que los autores consideraron \u00fatiles para aportar conocimiento al lector sobre los principios del TRRC, as\u00ed como proveer informaci\u00f3n sobre la disposici\u00f3n de los medicamentos.<\/jats:p>\n <\/jats:sec>\n \n S\u00cdNTESIS:<\/jats:title>\n TRRC utilizan filtraci\u00f3n y\/o convecci\u00f3n y en algunos casos difusi\u00f3n para tratar pacientes hemodinamicamente inestables con sobrecarga de fluidos y\/o fallo renal agudo. Informaci\u00f3n reciente sugiere que se pueden obtener resultados cl\u00ednicos positivos con otras condiciones de salud tales como choque septico, s\u00edndrome de disfunci\u00f3n de multiples \u00f3rganos, y fallo hep\u00e1tico. Factores como la edad, ventilaci\u00f3n mec\u00e1nica, terapia inotr\u00f3pica, volumen urinario reducido, y aumento en las concentraciones de bilirubina s\u00e9rica han sido asociados con resultados cl\u00ednicos desfavorables. Las complicaciones asociadas con TRRC incluyen sangramiento debido a exceso de anticoagulaci\u00f3n y desconecci\u00f3n de la linea, desbalance de fluidos y electrolitos, y formaci\u00f3n de coagulos venosos y en el filtro. El r\u00e9gimen de medicamentos se puede complicar en el paciente recibiendo TRRC cuando hay que mantener las concentraciones plasm\u00e1ticas de alg\u00fan f\u00e1rmaco dentro de un margen estrecho. Como las caracter\u00edsticas fisicoqu\u00edmicas del f\u00e1rmaco y algunos factores especificos del procedimiento pueden interactuar alterando la remoci\u00f3n de dicho f\u00e1rmaco, una evaluaci\u00f3n detallada de todos los factores debe considerarse antes de ajustar la posologia. Se proponen un algoritmo para consideraciones sobre posolog\u00eda basado en las caracter\u00edsticas del f\u00e1rmaco y del TRRC y ecuaciones farmacocin\u00e9ticas est\u00e1ndares.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONES:<\/jats:title>\n El uso del TRRC se ha expandido para incluir el tratamiento de otras condiciones de salud adem\u00e1s del fallo renal agudo. Debido a que existe gran variabilidad entre los centros de tratamientos es prematuro concluir que en efecto la sobrevivencia mejora en los pacientes tratados con TRRC en comparaci\u00f3n con los que reciben hemodialisis convencional. Este compendio esperamos sea de utilidad para ayudar al practicante cl\u00ednico a entender la necesidad de individualizar estas terapias y prospectivamente optimizar la farmacoterapia de los pacientes que reciban TRRC.<\/jats:p>\n <\/jats:sec>\n \n OBJECTIF:<\/jats:title>\n D\u00e9crire les diverses techniques de th\u00e9rapie continue de remplacement r\u00e9nal (TCRR) chez les patients aux soins intensifs. Revoir les indications, les complications, les principes d'\u00e9limination des m\u00e9dicaments, l'individualisation des doses, et l'influence de cette th\u00e9rapie sur la morbidit\u00e9 et mortalit\u00e9 des patients.<\/jats:p>\n <\/jats:sec>\n \n REVUE DE LITT\u00c9RATURE:<\/jats:title>\n Une recherche informatis\u00e9e (1980\u20131996) a \u00e9t\u00e9 effectu\u00e9e avec les mots cl\u00e9s suivants: h\u00e9mofiltration, ultrafiltration, h\u00e9modialyse, h\u00e9modiafiltration, m\u00e9dication, et pharmacocin\u00e9tique ainsi que via les r\u00e9f\u00e9rences d'articles obtenus.<\/jats:p>\n <\/jats:sec>\n \n S\u00c9LECTION DES \u00c9TUDES:<\/jats:title>\n Les r\u00e9f\u00e9rences furent s\u00e9lectionn\u00e9es en fonction du potentiel d'augmentation du niveau de connaissance des principes de TCRR ainsi qu'en fonction de r\u00e9valuation des param\u00e8tres cin\u00e9tiques des m\u00e9dicaments.<\/jats:p>\n <\/jats:sec>\n \n R\u00c9SUM\u00c9:<\/jats:title>\n La TCRR utilise la filtration\/la convection et dans quelques cas la diffusion pour traiter les patients instables avec une surcharge liquidienne et\/ou une insuffisance r\u00e9nale aigu\u00eb. Des donn\u00e9es r\u00e9centes sugg\u00e8rent une am\u00e9lioration de la morbidit\u00e9 et mortalit\u00e9 chez les patients trait\u00e9s pour un choc septique, un syndrome de dysfonction d'organes multiples, et une insuffisance h\u00e9patique. l'\u00e2ge, le besoin d'un support respiratoire et h\u00e9modynamique, une r\u00e9duction du volume urinaire, et un taux \u00e9lev\u00e9 de bilirubine s\u00e9rique sont associ\u00e9s \u00e0 un pronostic moindre. Les complications de la TCRR incluent les saignements dus \u00e0 une anticoagulation excessive, des d\u00e9sordres liquidiens et \u00e9lectrolytiques, et la formation de caillots obstruant le filtre. La TCRR peut compliquer les r\u00e9gimes th\u00e9rapeutiques de ceux o\u00f9 il faut maintenir des concentrations s\u00e9riques dans un \u00e9cart \u00e9troit. Puisque les caract\u00e9ristiques physicochimiques du m\u00e9dicament peuvent en alt\u00e9rer son \u00e9limination, il importe d'\u00e9valuer tous les facteurs impliqu\u00e9s avant de d\u00e9terminer un dosage m\u00e9dicamenteux. De plus, un algorithme pour aider la recommandation de dosages en fonction du m\u00e9dicament, des caract\u00e9risques de la TCRR, et d'\u00e9quations de cin\u00e9tique est pr\u00e9sent\u00e9.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n Les indications de la TCRR ne se limitent plus \u00e0 l'insuffisance r\u00e9nale aigu\u00eb. \u00e9tant donn\u00e9 la variabilit\u00e9 entre les centres hospitaliers, il est pr\u00e9coce de conclure \u00e0 une survie am\u00e9lior\u00e9e avec ce type de th\u00e9rapie par rapport \u00e0 une h\u00e9modialyse standard. Cet article permettra aux cliniciens d'optimiser la th\u00e9rapie des patients recevant ce type de th\u00e9rapie r\u00e9nale.<\/jats:p>\n <\/jats:sec>","DOI":"10.1345\/aph.17105","type":"journal-article","created":{"date-parts":[[2004,3,11]],"date-time":"2004-03-11T17:08:19Z","timestamp":1079024899000},"page":"362-375","source":"Crossref","is-referenced-by-count":85,"title":["A Primer on Continuous Renal Replacement Therapy for Critically Ill Patients"],"prefix":"10.1177","volume":"32","author":[{"given":"Melanie S","family":"Joy","sequence":"first","affiliation":[{"name":"Melanie S Joy PharmD, Clinical Instructor and Research Coordinator, Division of Nephrology and Hypertension, School of Medicine, University of North Carolina, Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary R","family":"Matzke","sequence":"additional","affiliation":[{"name":"Gary R Matzke PharmD FCCP FCP, Professor of Medicine and Pharmaceutical Sciences, Center for Clinical 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