Outcomes

Kidney Function Restoration Program

Kidney Problems Causes and Treatment

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100806040

100806040

Days

Days

FIGURE 19-23

Efficacy of continuous renal replacement therapy (CRRT) versus intermittent hemodialysis (IHD): effect on blood urea nitrogen, A, and creatinine levels, B, in acute renal failure.

FIGURE 19-24

Blood urea nitrogen (BUN) levels in survivors and non-survivors in acute renal failure treated with continuous renal replacement therapy (CRRT). It is apparent that CRRT techniques offer improved solute control and fluid management with hemodynamic stability, however a relationship to outcome has not been demonstrated. In a recent retrospective analysis van Bommel [24] found no difference in BUN levels among survivors and non-survivors with ARF While it is clear that lower solute concentrations can be achieved with CRRT whether this is an important criteria impacting on various outcomes from ARF still needs to be determined. A recent study form the Cleveland Clinic suggests that the dose of dialysis may be an important determinant of outcome allowing for underlying severity of illness [25]. In this study the authors found that in patients with ARF, 65.4% of all IHD treatments resulted in lower Kt/V than prescribed. There appeared to be an influence of dose of dialysis on outcome in patients with intermediate levels of severity of illness as judged by the Cleveland Clinic Foundation acuity score for ARF (see Fig. 19-25). Patients receiving a higher Kt/V had a lower mortality than predicted. These data illustrate the importance of the underlying severity of illness, which is likely to be a major determinant of outcome and should be considered in the analysis of any studies.

ivur 0.4 Su

Cleveland clinic ICU ARF score

FIGURE 19-25

Effect of dose of dialysis in acute renal failure (ARF) on outcome from ARF.

BCM Group

BICM Group

Probability

Patients, n

72

B1

All patients recover of renal function

46 (64%)

35 (43%)

0.001

Survival

41 (57%)

37 (46%)

0.03

Patients nonoliguric before hemodialysis

39

46

Development of oliguria with dialysis

17 (44%)

32 (70%)

0.03

Recovery of renal function

31 (79%)

21 (46%)

0.0004

Survival

2B (74%)

22 (4B%)

0.003

Patients oliguric before hemodialysis

33

35

Recovery of renal function

15 (45%)

14 (40%)

ns

Survival

12 (36%)

15 (43%)

ns

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