Mortality In Acute Renal Failure Comparison Of Crrt Versus

IHD CRRT

Investigator

Type of Study

No

Mortality, %

No

Mortality, %

Change, %

PValue

Mauritz [32]

Retrospective

31

90

27

70

-20

ns

Alarabi [33]

Retrospective

40

55

40

45

-10

ns

Mehta [34]

Retrospective

24

B5

1B

72

-13

ns

Kierdorf [20]

Retrospective

73

93

73

77

-16

< 0.05

Bellomo [35]

Retrospective

167

70

B4

59

-11

ns

Bellomo [36]

Retrospective

B4

70

76

45

-25

< 0.01

Kruczynski [37]

Retrospective

23

B2

12

33

-49

< 0.01

Simpson [3B]

Prospective

5B

B2

65

70

-12

ns

Kierdorf [39]

Prospective

47

65

4B

60

-4.5

ns

Mehta [40]

Prospective

B2

41.5

B4

59.5

+ 1B

Continuous renal replacement therapy (CRRT) versus intermittent hemodialysis (IHD): effect on mortality. Despite significant advances in the management of acute renal failure (ARF) over the last four decades, the perception is that the associated mortality has not changed significantly [26]. Recent publications suggest that there may have been some improvement during the last decade [27]. Both IHD and peritoneal dialysis (PD) were the major therapies until a decade ago, and they improved the outcome from the 100% mortality of ARF to its current level. The effect of continuous renal replacement therapy on overall patient outcome is still unclear [28] . The major studies done in this area do not show a survival advantage for CRRT [29,30]. Although several investigators have not been able to demonstrate an advantage of these therapies in influencing mortality, we believe this may represent the difficulty in changing a global outcome which is impacted by several other factors [31]. It is probably more relevant to focus on other outcomes such as renal functional recovery rather than mortality. We believe that continued research is required in this area; however, there appears to be enough evidence to support the use of CRRT techniques as an alternative that may be preferable to IHD in treating ARF in an intensive care setting.

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