Comparison between continuous venovenous and intermittent hemodialysis in acute renal failure

Acute renal failure in the intensive care unit. Therapy overview, patient risk stratification, complications of renal replacement, and special circumstances

This article provides a basic definition of severity scoring among patients with acute renal failure and extends the definition into the types of dialysis support that are generally used in intensive care unit acute renal failure. Acute dialysis dosing and the problems that create a difference between chronic renal failure and acute renal failure support are described, the dialytic techniques and side effects and complications of each are compared, and nonrenal-based special situations in which extracorporeal therapy has been found to be helpful are defined.

Management of acute renal failure in the pediatric patient: hemofiltration versus hemodialysis

Although outcome data for acute renal failure (ARF) in the adult population (analyzed by etiology of ARF, severity of illness, and modality of treatment) are readily available, few similar data exist for the pediatric population. Pediatric survival rate data vary widely, based upon era of analysis, age and size of child, and cause of ARF. Few comparative data are available that address impact by modality chosen to treat ARF. Comparison of 122 children who were treated by hemodialysis (HD; n = 58) versus hemofiltration (HF; n = 64) reveals a combined survival rate of 65%. Survival by modality was higher for HD (83%) than for HF (48%). The major diagnosis treated with HF was sepsis (29/64; 45%), with a survival rate of 31%, whereas the major diagnosis treated with HD (27/58; 46%) was primary renal failure, with a survival rate of 96%. Seventy-one percent of children undergoing HF required pressor support for hypotension, whereas only 24% of those receiving HD needed pressor support (P < 0.01). We conclude that the choice of renal replacement therapy (RRT) modality needs to be determined by the best treatment available. To adequately evaluate therapy measures, further analyses of outcome need to consider those factors that determine choice of RRT and those that affect survival independent of ARF.