NEPHRO-News
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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