| Theme | The Choice of Blood Purification for the Patients with Renal Failure | |
|---|---|---|
| Title | Strategies for blood purification therapy in patients with brain injuries | |
| Publish Date | 2000/01 | |
| Author | Hideki Hirakata | Kidney Care Unit, Kyushu University Hospital |
| Author | Itsuko Ishida | Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyusyu University |
| [ Summary ] | In patients with brain injuries, requiring blood purification therapy (BPT), it is very important to prevent further neurological deterioration due to intracranial hypertension. Control of changes in the intracranial pressure (ICP) is, therefore, required. It is known that ICP rises steeply during conventional hemodialysis, whereas it remains stable during peritoneal dialysis (PD). Since there is no need for anticoaglulants with PD, it is also advantageous to use it for treatment of those with hemorrhagic brain injuries. However, poor control of hypervolemia and underdialysis, due to low efficiency are serious problems with PD therapy. Recently, many modifications in continuous renal replacement therapy (CRRT) have been developed and are quite useful for treatment of patients with brain injuries, where we use anticoagulants with short-half lives. One of these is continuous arteriovenous hemofiltration (CAVHF), which has been reported to achieve management of both ICP and perfusion to the brain. In patients with epilepsy or dementia, data concerning pharmacodynamics, such as protein binding capacity, metabolic pathways and the dialysability of anticonvulsant and psychotropic agents, should be reminded along with close monitoring the relationship between blood levels and resultant effects. It is important to select the safest method for BPT in those patients with brain injuries, in association with systemic blood pressure control, in order to maintain the perfusion pressure to the brain along with stable ICP. |
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