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Nephrol Dial Transplant (1999) 14: 2590-2594
© 1999 European Renal Association-European Dialysis and Transplant Association

Invited Comments

Critical care dialysis—a Gordian knot (but is untying the right approach?)

Nigel Suren Kanagasundaram and Emil Presley Paganini

Cleveland Clinic Foundation, Cleveland, OH, USA

Correspondence and offprint requests to: Dr N. S. Kanagasundaram, Section of Dialysis and Extracorporeal Therapy, M82, Cleveland Clinic Foundation, 9500, Euclid Avenue, Cleveland, OH 44195, USA.

Introduction

Dialysis support for the critically-ill patient with acute renal failure (ARF) is now under scrutiny [1], but despite the increasing attention many crucial questions remain unanswered. In this article, we examine some of the reasons for these ambiguities and discuss potential solutions.

The problems

The ESRF–ARF interface
Certain well-defined standards of dialysis support for the patient with end-stage renal failure (ESRF) have become basic tenets of nephrological practice [2]. Any suggestion of establishing similar standards in critical care dialysis is obviously premature, but can we generalize from our experience in ESRF?

Unfortunately, a number of crucial factors within the two, quite distinct populations, make extrapolations problematic.

Firstly, the pace of change in the intensive care unit (ICU) ARF population is very different; critical end-points are reached in days-to-weeks as opposed to the attrition that we are used to of months-to-years in ESRF patients, so dialysis efficacy will have to be judged . . . [Full Text of this Article]

High mortality
Choice of modality
Haemodynamic stability.
Dialysis dose delivery.
Removal of inflammatory mediators.
Outcome.
The future

Acknowledgments

References


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Intermittent versus continuous renal replacement therapy for acute kidney injury patients admitted to the intensive care unit: results of a randomized clinical trial
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[Abstract] [Full Text] [PDF]