| Theme |
Current trends and issues for medical management of acute kidney injury in Japan |
| Title |
Blood purification in critical care |
| Author |
Noriyuki Hattori |
Department of Artificial Kidney, Chiba University Hospital |
| Author |
Shigeto Oda |
Department of Artificial Kidney, Chiba University Hospital |
| [ Summary ] |
We reviewed the recommendations included in the KDIGO clinical practice guidelines for acute kidney injury related to blood purification in critical care, in comparison to the current situation in Japan. Concepts related to renal replacement therapy (RRT) modalities and vascular access were similar. Unfractionated or low-molecular weight heparin are common anticoagulants. Unless the patient has an increased risk of bleeding or impaired coagulation. Anticoagulation agents may be recommended to the patients at increased risk of bleeding were greatly different from those observed in Japan because nafamostat is not available in the USA or Europe. On the other hand, citrate is not approved in Japan as an anticoagulant for blood purification, as dictated by the Ministry of Health, Labour and Welfare. There seem to be no problems with buffer solutions or dialyzer membranes in Japan. However, further evidence will be needed as to whether some dialysis membranes are able to improve clinical outcomes in sepsis by removal of inflammatory mediators. Furthermore, the fact that dosages of RRT in Japan are limited to levels less than those in the USA or Europe by national health insurance remains a problem of great importance. |