Establishing a dialysis therapy/patient outcome link in intensive care unit acute dialysis for patients with acute renal failure

Paganini, Emil P.; Tapolyai, Mihály; Goormastic, M.; Halstenberg, William; Kozlowski, L.; Leblanc, Martine; Lee, Jar Chi; Moreno, Luz; Sakai, Ken

doi:10.1016/s0272-6386(96)90084-0

Cited by 198 publications

(128 citation statements)

References 31 publications

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“…24 Paganini et al found a male gender, non-surgical diagnostic group, and thrombocytopenia to be associated with mortality, but we found none of these to be significant. 29 They also found hyperbilirubinemia to be associated with mortality, which concurs with our results. These conflicting findings support the need for further modifications to critical care scoring systems, to incorporate the importance of renal insufficiency, hepatic insufficiency, and the use and type of vasoactive support.…”

supporting

confidence: 91%

Continuous renal replacement therapy improves renal recovery from acute renal failure

Jacka

Ivancinova

Gibney

2005

Can J Anesth/J Can Anesth

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B Ba ac ck kg gr ro ou un nd d: : Acute renal failure (ARF) occurs in up to 10% of critically ill patients, with significant associated morbidity and mortality. The optimal mode of renal replacement therapy (RRT) remains controversial. This retrospective study compared continuous renal replacement therapy (CRRT) and intermittent hemodialysis (IHD) for RRT in terms of intensive care unit (ICU) and hospital mortality, and renal recovery. M Me et th ho od ds s: :We reviewed the records of all patients undergoing RRT for the treatment of ARF over a 12-month period. Patients were compared according to mode of RRT, demographics, physiologic characteristics, and outcomes of ICU and hospital mortality and renal recovery using the Chi square, Student's t test, and multiple logistic regression as appropriate.R Re es su ul lt ts s: : 116 patients with renal insufficiency underwent RRT during the study period. Of these, 93 had ARF. The severity of illness of CRRT patients was similar to that of IHD patients using APACHE II (25.1 vs 23.5, P = 0.37), but they required significantly more intensive nursing (therapeutic intervention scale 47.8 vs 37.6, P = 0.0001). Mortality was associated with lower pH at presentation (P = 0.003) and increasing age (P = 0.03). Renal recovery was significantly more frequent among patients initially treated with CRRT (21/24 vs 5/14, P = 0.0003). Further investigation to define optimal timing, dose, and duration of RRT may be beneficial.C Co on nc cl lu us si io on ns s: : Although further study is needed, this study suggests that renal recovery may be better after CRRT than IHD for ARF. Mortality was not affected significantly by RRT mode.

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supporting

confidence: 91%

Continuous renal replacement therapy improves renal recovery from acute renal failure

Jacka

Ivancinova

Gibney

2005

Can J Anesth/J Can Anesth

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“…Over the past decade, CRRT therapies such as continuous arteriovenous hemofiltration (CAVH), continuous arteriovenous HD (CAVHD) and CAVHDF and their venovenous analogues (CVVH, CVVHD, CVVHDF), have become popular as the treatments of choice for critically ill patients who require dialysis. Although comparative studies (41,49,50) have failed to demonstrate any reduction in mortality with CRRT, when compared to IHD, and despite the disadvantages of these procedures (complexity, anticoagulation and prolonged immobilization that increase the risk of bleeding and nosocomial infection), there is a trend towards increased use of the most complicated and most expensive newer forms of dialysis.…”

Section: Contraindications To Acute Peritoneal Dialysismentioning

confidence: 99%

Peritoneal Dialysis in Acute Renal Failure

Passadakis

2003

Int J Artif Organs

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“…Prior studies have suggested that greater intensity of renal replacement therapy in ARF is associated with improved patient survival [6][7][8]; however, these have been limited in number and have had significant limitations in study designs. Ronco et al [8] compared three doses of continuous venovenous hemodiafiltration in 425 subjects with ARF at a single center.…”

Section: Limitations In the Design Of Prior Studiesmentioning

confidence: 99%

“…Other modalities, such as the continuous renal replacement therapies (CRRT) and sustained low efficiency dialysis (SLED) have gained increasing acceptance in the management of hemodynamically unstable patients. Although several recent clinical studies have suggested that more intensive renal support may improve survival [6][7][8], these data have not been widely accepted in clinical practice in the USA [4,9]. In addition, these studies evaluated individual modalities of therapy in isolation rather than evaluating strategies of care that parallel clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Design of the VA/NIH Acute Renal Failure Trial Network (ATN) study: intensive versus conventional renal support in acute renal failure

Palevsky

O’Connor²,

Zhang

et al. 2005

Clinical Trials

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The optimal management of renal replacement therapy (RRT) in acute renal failure (ARF) is uncertain. The VA/NIH Acute Renal Failure Trail Network Study (ATN Study) tests the hypothesis that a strategy of intensive RRT will decrease 60-day all-cause mortality in critically ill patients with ARF. Dose separation between the two treatment arms is achieved by increasing the frequency of intermittent hemodialysis (IHD) and sustained low efficiency dialysis (SLED) treatments from three times per week to six times per week, and by increasing continuous venovenous hemodiafiltration (CVVHDF) effluent volume from 20 mL/kg/hr to 35 mL/kg/hr. In both treatment arms, subjects convert between IHD and CVVHDF or SLED as hemodynamic status changes over time. This strategy attempts to replicate the conversion between modalities of RRT that occurs in clinical practice. However, in order to implement this strategy, flexible criteria needed to be developed to provide a balance between the need for uniformity of treatment between groups and practitioner discretion regarding modality of RRT to maintain patient safety. In order to address safety and ethical issues similar to those raised by the Office of Human Research Protections in its review of the ARDS Network studies, a survey of practitioner practices was performed and observational data on the management of RRT in comparable critically ill patients with ARF managed outside of the research context is being collected prospectively. These data will help inform the study's DSMB and site IRB's of the relationship between the study's treatment arms and concurrent clinical practice.

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Establishing a dialysis therapy/patient outcome link in intensive care unit acute dialysis for patients with acute renal failure

Cited by 198 publications

References 31 publications

Continuous renal replacement therapy improves renal recovery from acute renal failure

Continuous renal replacement therapy improves renal recovery from acute renal failure

Peritoneal Dialysis in Acute Renal Failure

Design of the VA/NIH Acute Renal Failure Trial Network (ATN) study: intensive versus conventional renal support in acute renal failure

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