ACUTE-RENAL-FAILURE IN THE 21ST-CENTURY - RECOMMENDATIONS FOR MANAGEMENT AND OUTCOMES ASSESSMENT

Acute renal failure (ARF) remains a common and potentially devastating disorder affecting as many of 5% of all hospitalized patients, with a higher prevalence in patients in critical care units. ARF is more fre quently observed in the setting of multiorgan dysfunction syndrome (MO DS) and in elderly patients with complex disease, where mortality is h igh. Numerous technical advances have not yet impacted favorably on th is high mortality rate. This report summarizes recommendations from pa rticipants at the National Institutes of Health Conference: ''Acute Re nal Failure in the 21st Century,'' May 6 to 8, 1996, in Bethesda, MD. The focus is on categorizing recent clinically relevant developments i n the field and on identification of new research initiatives to trans fer a new body of knowledge derived from fundamental studies and labor atory investigation to the management of ARF in the new millennium. Th e development of a multicenter database through cooperative multicente r studies is advocated. Future studies should define the appropriate o utcome measures to assess and emphasize the impact of hemodynamic moni toring, adjunctive agents, and adequacy and modality of renal replacem ent therapy on outcomes in ARF. (C) 1997 by the National Kidney Founda tion, Inc.