Continuous renal replacement therapy for acute renal failure on the intensive care unit

During the last decade, impressive advances have been made in the techniques available for the treatment of ARF in critically ill patients. This has led to the increased use of continuous hemofiltration and its derived modifications on the intensive care unit (lCU) as opposed to the use of intermittent hemodialysis and peritoneal dialysis. In spite of this, it has not been possible to demonstrate an improved outcome in these patients, which is ascribed to a change in patient characteristics. One major reason for our failure to demonstrate enhanced survival may be the lack of validated and objective illness severity scores that would allow an adequate comparison of outcome data from different reports. Today, ARF is most often encountered in the setting of the systemic inilanuuatory response syndrome (SIRS), usually as a result of sepsis, which is characterized by the release of a myriad of inflammatory mediators with vasoactive and cardiodepressant properties into the circulation. It has been suggested that these middle- and large molecular weight mediators may pass the membranes that are used in continuous renal replacement techniques (CRRT) and that this may have a beneficial effect on the clinical course in critically ill patients with ARF. There is, however, still much controversy as to which dialytic treatment modality should be preferred in the setting of ARF on the ICU.

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