Does continuous renal replacement therapy favourably influence the outcome of the patients?

Jakob, Stephan M.; Frey, Felix J.; Uehlinger, Dominik E.

doi:10.1093/ndt/11.7.1250

Cited by 46 publications

(17 citation statements)

References 54 publications

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“…In the US, CRRT was utilized in less than 10% of cases in 1995, although it appeared that this course of therapy was also favored by academic institutions. The acceptance by the academic communities is interesting given the lack of definitive evidence supporting a superior outcome with CRRT compared to IHD [10,11]. Indeed, a recent prospective study failed to demonstrate any mortality reduction with CRRT compared to IHD [12].…”

Section: Discussionmentioning

confidence: 99%

Current Canadian Approaches to Dialysis for Acute Renal Failure in the ICU

Hyman

Mendelssohn²

2002

Am J Nephrol

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Background: Although there is a very high mortality rate (>50%) with acute renal failure (ARF) in the intensive care unit (ICU), there is no general consensus on the best dialysis treatment for this condition. Methods: We surveyed by mail questionnaire, all adult academic and community registered Canadian nephrology centers that offer treatment for ARF. Results: The overall response rate was 59% (53/90). Comparing current dialysis methods with those utilized 5 years ago, the largest increase was in continuous renal replacement therapies (CRRT) (26 vs. 9%). Both intermittent hemodialysis (IHD) and peritoneal dialysis decreased in utilization. The predominant current CRRT methods utilized venovenous access (80%), as compared to 5 years ago when arteriovenous was the most common (52%). Despite data from chronic dialysis (and preliminary data in ARF) suggesting reduced mortality and morbidity with increasing dialysis dose, there was no formal method of dialysis prescription monitoring in over 75% of the centers. Conclusion: Notwithstanding a lack of definitive evidence of superior outcomes with CRRT compared to older methods, the utilization of CRRT is dramatically increasing for the treatment of ARF in Canada. Whether this shift towards CRRT, and whether more attention to dialysis dose in ARF, might be expected to lead to better outcomes, requires further evaluation.

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Section: Discussionmentioning

confidence: 99%

Current Canadian Approaches to Dialysis for Acute Renal Failure in the ICU

Hyman

Mendelssohn²

2002

Am J Nephrol

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“…Intuitively, it may be seen as the modality of choice (Table 5), but there are no convincing data to suggest a superior outcome to conventional dialysis. 25,26 The removal of inflammatory mediators during CRRT has been mooted as a potential advantage over intermittent haemodialysis (IHD). There is, however, a lack of consistent human data and a disparity between the high endogenous turnover of these mediators and their negligible extracorporeal clearance.…”

Section: Renal Replacement Therapymentioning

confidence: 99%

Acute renal failure on the intensive care unit

Kanagasundaram

Paganini

2005

Clinical Medicine

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“…Die Mehrzahl der publizierten Studien zu dieser Fragestellung sind retrospektive, nichtrandomisierte Untersuchungen (Übersicht in [16]). Es gibt Befunde, die einen positiven Effekt der kontinuierlichen Hämofiltration zu belegen scheinen; es gibt aber auch Studien, die keinen Unterschied zwischen kontinuierlichen und intermittierenden Verfahren aufdecken konnten.…”

Section: üBerleben Bei Anv: Kontinuier-liche Hämofiltration Versus Inunclassified

Extrakorporale Therapieverfahren bei akutem Nierenversagen

Schaefer

Barenbrock

Teschner³

et al. 2000

Med Klin

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The most serious forms of acute renal failure (ARF) are nowadays encountered in the intensive care unit (ICU), where up to 25% of new patients are reported to develop ARF. Lethality rates may reach 50 to 90% when the ARF is part of a multiple organ dysfunction syndrome. A multitude of extracorporeal procedures have been introduced into intensive care medicine. Applied with adequate skills and experience, most of these techniques will suffice to replace excretory renal function. However, because of low efficacy arterio-venous procedures (CAVH and CAVHD) have been abandoned for the veno-venous, pump-driven techniques (CVVH and CVVHD). Up to now, there is no consensus whether continuous or intermittent renal replacement therapy is more advantageous. In many cases, oliguric patients with circulatory instability will be treated by CVVH, even though there is no prospective study to show that in terms of outcome continuous treatment is superior to intermittent hemodialysis. It is equally conceivable to treat such patients with daily, prolonged (intermittent) hemodialysis. Apparently, the dose of replacement therapy, be it continuous filtration (36 to 48 l/24 h) or intermittent hemodialysis (daily 3 to 4 h) with a target BUN of less than 50 mg/dl, is more important than the modality of treatment. Moreover, there is good evidence that the use of biocompatible membranes (no complement- or leukocyte activation) is preferable and that with high-volume hemofiltration bicarbonate-containing replacement fluids should be used. However, despite all the technical advances, we firmly believe that the skills and the experience of those physicians and nurses who actually perform renal replacement therapy in the ICU are more important than the modality of treatment applied.

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Does continuous renal replacement therapy favourably influence the outcome of the patients?

Cited by 46 publications

References 54 publications

Current Canadian Approaches to Dialysis for Acute Renal Failure in the ICU

Current Canadian Approaches to Dialysis for Acute Renal Failure in the ICU

Acute renal failure on the intensive care unit

Extrakorporale Therapieverfahren bei akutem Nierenversagen

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