Thursday, March 29, 2018

TBI patients and dialysis

Q: Which of the following modality is preferred in hemodynamically stable patients with traumatic brain injury (TBI)? (select one)

A) Intermittent Hemodialysis (HD)
B) Continuous Renal Replacement Therapy (CRRT)

Answer: B

Most critically ill patients with renal failure who are hemodynamically stable can be served with less labor intense HD. But patients with traumatic brain injury (TBI) or at high risk of developing increased intracranial pressure (ICP) benefit more from CRRT. 

Intermittent HD can harm patients with TBI via two mechanisms.

1. Rapid removal of urea causes a rapid shift of water to the intracellular space resulting in worsen cerebral edema.

2. Drop in mean arterial pressure (MAP) during HD results in compensatory cerebral vasodilation resulting in worsening cerebral edema. 



Macedo E, Mehta RL. Continuous Dialysis Therapies: Core Curriculum 2016. Am J Kidney Dis 2016; 68:645.

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