Scheinkestel CD, Myles PS, Tuxen DV, Cooper DJ
Renal replacement therapy in the critically ill
International Society of Blood Purification
Blood Purif
(Sep) 13:(supp.1)13 1995
In most Australian ICUs, critical care specialists manage ARF with continuous
renal replacement therapy
(CRRT). CRRT has become the most prevalent form of 'dialysis' in Australian
ICUs.
Scheinkestel's approach of continuous veno-venous hemodiafiltration provides
40-80 liters/d of
urea clearance through noncomplement activating membranes. They noted a 34%
survival rate
in patients with 3 or more failing organs. Outcome predictors were number of
failed organs and
age greater than 65 years. The laudable facets of this report were in the
proper utilization of APACHE II
scoring (in contradistinction to the improper use of this score in two
landmark papers which
examined outcomes and renal replacement therapy in acute renal failure [Hakim
et al NEJM
331:1338, 1994 and Schiffl et al, Lancet 344:570, 1994]), the uniformity of
the intensive care,
and the quantity and nature of the renal replacement therapy. Their results
strongly suggest that
they are doing something better than many other centers. This may relate to
the nature of CRRT or to the very large urea clearances delivered.
(T.A. Golper)
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International Society of Blood Purification
Basic hemodialysis :
(Intermittent) dialysis for ARF