Recommendation For Initial Dialysis Modality For Acute Renal Failure

Indication

Clinical Condition

Preferred Therapy

Uncomplicated ARF

Antibiotic nephrotoxicity

IHD, PD

Fluid removal

Cardiogenic shock, CP bypass

SCUF, CAVH

Uremia

Complicated ARF in ICU

CVVHDF, CAVHDF, IHD

Increased intracranial pressure

Subarachnoid hemorrhage,

CVVHD, CAVHD

hepatorenal syndrome

Shock

Sepsis, ARDS

CVVH, CVVHDF, CAVHDF

Nutrition

Burns

CVVHDF, CAVHDF, CVVH

Poisons

Theophylline, barbiturates

Hemoperfusion, IHD, CVVHDF

Electrolyte abnormalities

Marked hyperkalemia

IHD, CVVHDF

ARF in pregnancy

Uremia in 2nd, 3rd trimester

Recommendation for initial dialysis modality for acute renal failure (ARF). Patients with multiple organ failure (MOF) and ARF can be treated with various continuous therapies or IHD. Continuous therapies provide better hemodynamic stability; however, if not monitored carefully they can lead to significant volume depletion. In general, hemodynami-cally unstable, catabolic, and fluid-overloaded patients are best treated with continuous therapies, whereas IHD is better suited for patients who require early mobilization and are more stable. It is likely that the mix of modalities used will change as evidence linking the choice of modality to outcome becomes available. For now, it is probably appropriate to consider all these techniques as viable options that can be used collectively. Ideally, each patient should have an individualized approach for management of ARF.

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