A comparison of continuous renal replacement therapy to intermittent dialysis in the management of renal insufficiency in the acutely III surgical patient.

نویسندگان

  • Jimmy Waldrop
  • David L Ciraulo
  • Timothy P Milner
  • Douglas Gregori
  • Aaron S Kendrick
  • Charles M Richart
  • Robert A Maxwell
  • Donald E Barker
چکیده

Acute renal failure (ARF) occurs in 10 per cent to 23 per cent of intensive care unit patients with mortality ranging from 50 per cent to 90 per cent. ARF is characterized by an acute decline in renal function as measured by urine output (UOP), serum creatinine, and blood urea nitrogen (BUN). Causes may be prerenal, intrarenal, or postrenal. Treatment consists of renal replacement therapy (RRT), either intermittent (ID) or continuous (CRRT). Indications for initiation of dialysis include oliguria, acidemia, azotemia, hyperkalemia, uremic complications, or significant edema. Overall, the literature comparing CRRT to ID is poor. No studies of only surgical/trauma patients have been published. We hypothesize that renal function and hemodynamic stability in trauma/ surgical critical care patients are better preserved by CRRT than by ID. We performed a retrospective review of trauma/surgical critical care patients requiring renal supportive therapy. Thirty patients received CRRT and 27 patients received ID. The study was controlled for severity of illness and demographics. Outcomes assessed were survival, renal function, acid-base balance, hemodynamic stability, and oxygenation/ventilation parameters. Populations were similar across demographics and severity of illness. Renal function, measured by creatinine clearance, was statistically greater with CRRT (P = 0.035). There was better control of azotemia with CRRT: BUN was lower (P = 0.000) and creatinine was lower (P = 0.000). Mean arterial blood pressure was greater (P = 0.021) with CRRT. No difference in oxygenation/ventilation parameters or pH was found between groups. CRRT results in an enhancement of renal function with improved creatinine clearance at the time of dialysis discontinuation. CRRT provides better control of azotemia while preserving hemodynamic stability in patients undergoing renal replacement therapy. Prospective randomized controlled studies and larger sample sizes are needed to further evaluate these modalities.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Renal replacement therapy III: IHD, CRRT, SLED.

Acute renal failure in critically ill patients is a growing clinical problem. Options for renal replacement therapy in these patients use convective and diffusive clearance and may be intermittent, as in classic hemodialysis, or continuous. New ways of delivering dialysis in the intensive care unit, such as sustained low-efficiency dialysis, are also under development. It may be that renal repl...

متن کامل

Continuous renal replacement therapy.

Continuous renal replacement therapy (CRRT) is a blood purification modality that uses a combination of convection and diffusion to eliminate uremic toxins and correct electrolyte imbalances. Although CRRT is usually associated with the treatment of acute renal failure, it can also be useful in treating many types of toxicoses and drug overdoses. Unlike intermittent hemodialysis, in which the p...

متن کامل

بررسی دیالیز صفاقی سرپایی دایم به عنوان روشی جهت درمان جای‌گزینی نارسایی مزمن کلیوی(گزارش 37 مورد در مرکز پزشکی شهید هاشمی‌نژاد)

Continuous ambulatory peritoneal dialysis(CAPD) is a well-known model of renal replacement therapy for end-stage renal disease patients in developed countries. This model of treatment has widely been used in our country in recent years. The present study was undertaken to investigate the efficacy of CAPD in Iran, patient population, medical and surgical complications and the etiolog...

متن کامل

A randomized clinical trial of continuous versus intermittent dialysis for acute renal failure.

BACKGROUND Acute renal failure (ARF) requiring dialysis in critically ill patients is associated with an in-hospital mortality rate of 50 to 80%. The worldwide standard for renal replacement therapy is intermittent hemodialysis (IHD). Continuous hemodialysis and hemofiltration techniques have recently emerged as alternative modalities. These two therapies have not been directly compared. METH...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • The American surgeon

دوره 71 1  شماره 

صفحات  -

تاریخ انتشار 2005