Chapter 65 - Extracorporeal Renal Replacement

Abstract

Acute renal failure (ARF) and end-stage renal disease (ESRD) continue to have high mortality rates. Standard care for these diseases includes dialysis therapy, which only replaces the filtration function of the kidney, not the critical transport, metabolic, and endocrine renal functions. More complete replacement of these functions may improve the treatment of renal diseases. A renal assist device containing living renal cells has been successfully engineered, and when used in conjunction with continuous hemofiltration it has been shown in preclinical and clinical studies to provide more complete renal replacement therapy and improve patient survival in acute kidney injury and multiorgan failure. Therapy affects systemic leukocyte activation and cytokines, which suggests that cell therapy may improve morbidity and mortality by altering inflammation. Bioartificial renal epithelial cell systems and selective cytopheretic devices are developing extracorporeal technologies with promise for enhancing the treatment of patients with ARF and ESRD.