Emerging therapies for extracorporeal support.
Dialytic therapies have undergone major technological developments in the last decade and emerging techniques are promoted not only for acute kidney injury, but also for sepsis, acute decompensated heart failure, and acute and acute-on-chronic liver failure. New devices specifically target the pathophysiological mechanisms involved in these conditions. In septic shock and sepsis, high-volume hemofiltration, coupled plasma filtration adsorption, cascade hemofiltration and high permeability hemofiltration enhance removal of pro-inflammatory mediators, while in liver failure, Molecular Adsorbents recycling System (MARS) and Prometheus favor the elimination of albumin-bound toxins such as bilirubin. In acute decompensated heart failure, simplified ultrafiltration machines are used to reach negative fluid balance in a minimalist setting. In the context of limited resources and growing expansion in the availability of technologies, a critical assessment is required and the use of these devices needs to be put in perspective. This article reviews the mechanisms, advantages and limitations of these techniques along with the current evidence available regarding their influence on major clinical outcomes.
Bouchard
Josée
J
University of California at San Diego, San Diego, CA 92103, USA.
Khosla
Nitin
N
Mehta
Ravindra L
RL
D058186:Acute Kidney Injury / Q000534:rehabilitation*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005544:Forecasting; D006801:Humans; D006435:Renal Dialysis / Q000295:instrumentation* / Q000379:methods / Q000639:trends*