Continuous renal replacement therapies versus intermittent hemodialysis in acute renal failure: What do we know?

The mortality of complicated acute renal failure (ARF) has remained unchanged in the last 10 years and is currently near 70% because of the fact that ARF is part of a multiple organ dysfunction syndrome (MODS), Continuous renal replacement therapies (CRRTs) have become well established in the treatment of ARF since the introduction of continuous arteriovenous hemofiltration, While this simple blood pressure-driven treatment often failed to control azotemia, especially in MODS patients, modern CRRT (ie, pump-driven methods, dialysis) display higher efficacy in controlling azotemia. The main advantages of CRRT as opposed to intermittent hemodialysis (IHD) are greater hemodynamic stability, avoidance of rapid fluid and electrolyte shift, nutrition without restriction, adapted to the needs of the critically ill, and the use of more biocompatible membranes, The uninterrupted necessity for anticoagulants is the most important disadvantage. The question of whether patients may profit from the continuous elimination of mediators involved in ARF and MODS is still open. In retrospective analysis, CRRTs appear to reduce mortality compared with IHD. Unfortunately, these studies are often not comparable according to different patient collectives as reflected by the varying mortality (33% to 93%), Prospective, randomized studies are necessary to clearly demonstrate a benefit of CRRT as opposed to IHD in the treatment of critically ill patients with ARF. (C) 1996 by the National Kidney Foundation, Inc.