Recent Clinical Advances in the Management of Critically Ill Patients with Acute Renal Failure
Open Access
- 1 December 2006
- journal article
- research article
- Published by S. Karger AG in Blood Purification
- Vol. 24 (5-6), 487-498
- https://doi.org/10.1159/000095929
Abstract
Background: Significant progress has been made in the field of renal replacement therapy for critically ill patients with acute renal failure (ARF) over the past few years. This review highlights these developments. Methods: Recent studies assessing the clinical utility of the RIFLE classification system for the diagnosis of ARF were reviewed. Clinical outcome studies evaluating the effect of continuous renal replacement therapy (CRRT) dose and timing of initiation were assessed. The final review topic was the effect of dialysis modality on the recovery of renal function in ARF patients. Conclusions: Based on recent clinical studies, the increasing use of the RIFLE criteria is justified, as this approach appears to be a robust method for both the diagnosis of and prognostication in ARF. A large randomized trial involving convective CRRT supports the commonly used prescription of 35 ml/ kg/h in clinical practice. Moreover, numerous recent outcome studies, also largely involving convective CRRT, provide a clinical rationale for the increasingly common clinical practice of earlier initiation. Finally, several recent studies suggest CRRT, relative to conventional hemodialysis, results in a greater rate of renal recovery in ARF patients.Keywords
This publication has 55 references indexed in Scilit:
- The Outcome of Acute Renal Failure in the Intensive Care Unit According to RIFLE: Model Application, Sensitivity, and PredictabilityAmerican Journal of Kidney Diseases, 2005
- Acute Kidney Injury, Mortality, Length of Stay, and Costs in Hospitalized PatientsJournal of the American Society of Nephrology, 2005
- Immediate Postoperative Renal Function Deterioration in Cardiac Surgical Patients Predicts In-Hospital Mortality and Long-Term SurvivalJournal of the American Society of Nephrology, 2005
- Early hemofiltration improves survival in post-cardiotomy patients with acute renal failureEuropean Journal of Cardio-Thoracic Surgery, 2004
- Convective renal replacement therapies for acute renal failure and end‐stage renal diseaseHemodialysis International, 2004
- Early start on continuous hemodialysis therapy improves survival rate in patients with acute renal failure following coronary bypass surgeryHemodialysis International, 2004
- Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients*Critical Care Medicine, 2002
- Diffusive vs. convective therapyCritical Care Medicine, 1998
- Survivors of acute renal failure who do not recover renal functionQJM: An International Journal of Medicine, 1996
- A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter studyJAMA, 1993