THE ROLE OF CONTINUOUS RENAL REPLACEMENT THERAPY IN THE FUTURE TREATMENT OF ACUTE-RENAL-FAILURE

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.