Dialysis 101. Acute and chronic fluid shifts.
For over 30 years, dialysis has been accepted as a proven therapeutic intervention in sustaining life for patients with end-stage renal disease. As a renal replacement therapy, dialysis only approximates renal function. Derangements in fluids, electrolytes, and acid-base homeostasis occur in the course of progressive renal insufficiency. Nephrons are able to adapt to physiologic needs and maintain a balance for many solutes, until the very late stages of chronic renal failure. This permits survival of the patient with minimal therapeutic intervention. The availability of highly permeable membranes has allowed development of continuous renal replacement therapies that gradually remove fluids and solutes resulting in better hemodynamic stability.
Irefin
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Division of Anesthesiology and Critical Care Medicine, Cleveland Clinic Foundation, Ohio, USA. Irefins@ccf.org
D018495:Fluid Shifts; D006801:Humans; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000503:physiopathology* / Q000628:therapy; D013514:Surgical Procedures, Operative