What Dialysis Dose Should Be Provided in Acute Renal Failure? A Review

摘要: Increased dialysis dose has been shown to improve morbidity and survival in chronic hemodialysis patients. Despite improvement care technological aspects of renal replacement therapy, mortality rates acute failure (ARF) have remained essentially unchanged for over two decades, exceeding 50% most studies. The occurrence ARF older patients with more complicated medical surgical conditions contributed this lack outcome amelioration, death is now frequently caused by underlying disease than itself. A recent prospective survey at institution found a rate 79.1% among total 363 intensive unit patients, mean age near 60 years admission APACHE II score 20, who were treated intermittent continuous therapy (CRRT). Nonsurvivors had four failed systems, addition the failure, compared survivors less four. standards adequacy are not currently defined. catabolism seen may justify large delivery. An apparent influence delivered on recently observed our institution. Compared nonsurvivors, received significantly higher dose, as assessed Kt/V urea reduction ratio. In discrepancy between versus prescribed be particularly important following: reduced blood flow time consequent patient intolerance; lower dialyzer vivo clearances, heparin-free dialysis; recirculation when using temporary vascular access; postdialysis rebound. Prolonging course one risks attributed frequent hypotension ultrafiltration combined deficient autoregulation can result further damage. detrimental effects bioincompatible membranes demonstrated an induced-delay function recovery. study reported benefits biocompatible terms potential recovery maintenance urine output during dialytic support membranes. CRRT offers many advantages patients: better hemodynamic tolerance, avoidance solute rebound, removal serum sepsis mediators. However, yet firmly rates. Recently, kinetics used estimate provided CRRT. stable metabolic azotemia control observed. Cumulative Kt/V, every other day hemodialysis.