Renal Function and Icu

Introduction: The mortality of acute renal failure (ARF) is 50-80% in critically ill patients and has not fallen significantly despite numerous advances in critical care strategies and renal replacement technologies over several decades. (1) A major problem with conducting research into acute renal failure (ARF) is the lack of a consensus definition (2). More than 30 different definitions of ARF have been used in the literature. This lack of a common reference point created confusion and made comparisons difficult. The Acute Dialysis Initiative (ADQI) group of experts developed and published a consensus definition of ARF. This definition goes under the acronym of RIFLE. This definition classified the patients with renal dysfunction according to the degree of impairment into patient at risk (R), with injury (I), with failure (F), with sustained loss (L) and with end stage (E) status in relation to their renal function. (2) Rifle criteria were based on changes in the patients’ glomerular filtration rate (GFR) and/or their urine output. (2) Discussion: The prophylactic and therapeutic use of dopamine, the more studied vasoactive drug, actually has not been supported. For all other vasoactive drugs, at this moment, data available are contradictory and few conclusions can be made. To protect renal function, despite wide use of vasoactive drugs, only the maintenance of adequate volume replacement and perfusion pressure may be certainly recommended. Conclusion: The use of vasoactive drugs is a pervasive practice in intensive care units, and hence, this area needs suitably powered, multi-center, randomized, placebo-controlled, double-blind studies to provide more rational indications for clinical practice. GIORGIO DELLA ROCCA Professor of Anestesia