Figure 1918

Kidney Function Restoration Program

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Dialysis intervention in acute renal failure (ARF): renal replacement versus renal support. An important consideration in the management of ARF is defining the goals of therapy. Several issues must be considered, including the timing of the intervention, the amount and frequency of dialysis, and the duration of therapy. In practice, these issues are based on individual preferences and experience, and no immutable criteria are followed [7,23]. Dialysis intervention in ARF is usually considered when there is clinical evidence of uremia symptoms or biochemical evidence of solute and fluid imbalance. An important consideration in this regard is to recognize that the patient with ARF is somewhat different than the one with endstage renal disease (ESRD). The rapid decline of renal function associated with multiorgan failure does not permit much of an adaptive response which characterizes the course of the patient with ESRD. As a consequence, the traditional indications for renal replacement may need to be redefined. For instance, excessive volume resuscitation, a common strategy for multiorgan failure, may be an indication for dialysis, even in the absence of significant elevations in blood urea nitrogen. In this respect, it may be more appropriate to consider dialysis intervention in the intensive care patient as a form of renal support rather than renal replacement. This terminology serves to distinguish between the strategy for replacing individual organ function and one to provide support for all organs.

Renal Replacement

Renal Support

Extrarenal Applications

Acute renal failure

Fluid management

Cytokine removal ? sepsis

Chronic renal failure

Solute control

Heart failure

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