Jd. Conger, THE ROLE OF CONTINUOUS RENAL REPLACEMENT THERAPY IN THE FUTURE TREATMENT OF ACUTE-RENAL-FAILURE, American journal of kidney diseases, 28(5), 1996, pp. 108-113
In considering continuous renal replacement therapy (CRRT) in future t
herapeutic regimens for acute renal failure (ARF), three relevant area
s of interest have been examined: changes in the nature and perception
of ARF as an illness; the emerging roles of CRRT in ARF management; a
nd the use of dialysis modes in conjunction with newer pharmacologic t
reatments in ARF, Regarding changing patterns and perceptions of ARF,
there are a number of important issues in relation to future therapy,
ARF in the 1990s is predominantly a nonoliguric disorder that has a be
tter outcome than oliguric ARF and may have a positive effect on overa
ll mortality compared with previous decades, Rates of increases of ser
um creatinine (Scr) and blood urea nitrogen (BUN) levels in the curren
t decade are little changed, however, in large part because of catabol
ism and high protein infusion formulae, Of related interest is recent
information that baseline serum creatinine is a poor predictor of subs
equent dialysis need and mortality in ARF. Other outcome predictive sc
oring systems, while improved, still lack the precision for general ap
plication in patient treatment decisions, Given that there is increasi
ng evidence of abnormal vascular reactivity predisposing to recurrent
ischemia in ARF and new evidence of negative renal effects of bioincom
patible dialyzer membranes, the issue of early and intensive dialysis
in ARF needs to be re-examined using CRRT with biocompatible membranes
, rather than standard intermittent dialysis, Finally, pharmacologic a
gents currently under study that may have clinical efficacy have varia
ble levels of hypotensive side effects, It is very likely that when co
mbination treatment using dialysis and these newer drugs is considered
, it will require CRRT. (C) 1996 by the National Kidney Foundation, In
c.