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The role of intermittent dialysis in ARF patients


Dialysis therapy of acute renal failure (ARF) patients is still the subject of a number of controversies, which include the choice between continuous renal replacement therapies (CRRT) and the intermittent forms of haemodialysis (IHD), the dose of dialysis. and the possible impact of the biocompatibility of the haemodialysis membranes.

Continuous versus intermittent hemodialysis

A meta-analysis concluded that even large and prospective studies comparing these different dialysis strategies on outcome of patients of all ages with ARF were inconclusive (Am J Kidney Dis 40:875-885, 2002). Many studies have suggested a greater hemodynamic stability in patients on CRRT, compared to IHD. However, the only one cross-over study that to date has been performed did not find a difference in hemodynamic tolerance of CRRT compared to IHD (Intensive Care Med 22:742-746, 1996) and when certain guidelines are followed, such as use of biocompatible membranes, cool dialysate, a blood flow of < 150 ml, a dialysis session of at least 4h, and slow or no ultrafiltration at the start of the session, acceptable cardiovascular stability can also be achieved in hemodynamically unstable patients treated with intermittent hemodialysis.

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