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

Abstract

Continuous haemodialysis and continuous haemofiltration are efficient and safe techniques for the treatment of acute renal failure. Theoretical advantages are improved haemodynamic stability and easier fluid removal. All 15 available studies comparing intermittent (522 patients) with continuous (651 patients) renal replacement therapy have been reviewed. From these studies it cannot be established, whether the use of a continuous instead of an intermittent treatment modality improves the outcome in patients with acute renal failure. Reviewing all 67 published studies dealing with continuous renal replacement therapy revealed a trend to a decreasing mortality rate (/><0.08) over the last 11 years, whereas the mean age and the severity of illness of the patients, measured by the APACHE II score, did not change. In order to establish whether the quality of treatment has improved as a function of time, two quality factors (QF) were created, i.e. QF for age (mean age/mean mortality rate of the patients treated) and QF for severity of diseases (mean APACHE II/mean mortality rate). Both QF improved from 1984 until 1994, when analyzed for continuous (P< 0.001) or intermittent (P< 0.001) treatment modality. Thus the quality of treatment of patients with acute renal failure improved during the last decade. However, there is no evidence with respect to survival rate that a continuous renal replacement therapy is superior to an intermittent one.

Use of continuous renal replacement therapy for treatment of dogs and cats with acute or acute‐on‐chronic renal failure: 33 cases (2002–2006)

“…Specific advantages of CRRT over IHD proposed in the human literature include improved hemodynamic tolerance due to slower ultrafiltration, improved fluid balance, ability to provide unlimited nutrition, and improved control of azotemia, electrolyte and acid‐base derangements 10 . Despite these specific advantages, human prospective studies comparing outcome with IHD versus CRRT in ARF provide insufficient data to afford one modality a clear advantage over the other 11–14 . A summary of results of recent comparisons has been published 10 .…”

“…10 Despite these specific advantages, human prospective studies comparing outcome with IHD versus CRRT in ARF provide insufficient data to afford one modality a clear advantage over the other. [11][12][13][14] A summary of results of recent comparisons has been published. 10 Given the availability of CRRT equipment in veterinary medicine and reports of similar outcome with CRRT and IHD in human ARF patients, the current study aimed to investigate the application of CRRT in veterinary ICU patients with ARF and AOCRF.…”

Acute renal failure in the surgical setting

“…In the only crossover study to assess this to date, no difference in haemodynamic tolerance of CRRT compared to IHD was observed 117 . Also, no survival advantage has been attributed to a particular dialysis modality 118,119 . It is appreciated that both techniques have limitations and consequently a technique has been proposed that is referred to as ‘slow extended daily (haemo) dialysis’ that combines the benefits of both CRRT and IHD.…”

Continuous Venovenous Hemofiltration and Hemoperfusion in Successful Treatment of a Patient with Crush Syndrome and Acute Pancreatitis

“…CRRT exhibits more advantages in CS with acute pancreatitis compared with IRRT, including improved hemodynamics, easier fluid removal, flexibility with parenteral nutrition, and the steady removal of inflammation. 10 Myoglobin, a 17 kDa molecule, cannot be removed by hemodialysis, but RRT is an effective treatment for removal of myoglobin and cytokines, including interleukin-1 (IL-1), IL-6, and TNF-alpha, which are increased in sepsis and related to a poor prognosis. 11 Severe infection was another important etiological factor in this case.…”