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Canadian Journal of Anesthesia

, Volume 52, Issue 3, pp 327–332 | Cite as

Continuous renal replacement therapy improves renal recovery from acute renal failure

  • Michael J. JackaEmail author
  • Xenia Ivancinova
  • R. T. Noel Gibney
Article

Abstract

Background

Acute renal failure (ARF) occurs in up to 10% of critically ill patients, with significant associated morbidity and mortality. The optimal mode of renal replacement therapy (RRT) remains controversial. This retrospective study compared continuous renal replacement therapy (CRRT) and intermittent hemodialysis (IHD) for RRT in terms of intensive care unit (ICU) and hospital mortality, and renal recovery.

Methods

We reviewed the records of all patients undergoing RRT for the treatment of ARF over a 12-month period. Patients were compared according to mode of RRT, demographics, physiologic characteristics, and outcomes of ICU and hospital mortality and renal recovery using the Chi square, Student’s t test, and multiple logistic regression as appropriate.

Results

I 16 patients with renal insufficiency underwent RRT during the study period. Of these, 93 had ARF. The severity of illness of CRRT patients was similar to that of IHD patients using APACHE II (25.1 vs 23.5, P = 0.37), but they required significantly more intensive nursing (therapeutic intervention scale 47.8 vs 37.6, P = 0.0001 ). Mortality was associated with lower pH at presentation (P = 0.003) and increasing age (P = 0.03). Renal recovery was significantly more frequent among patients initially treated with CRRT (21/24 vs 5/14, P = 0.0003). Further investigation to define optimal timing, dose, and duration of RRT may be beneficial.

Conclusions

Although further study is needed, this study suggests that renal recovery may be better after CRRT than IHD for ARF. Mortality was not affected significantly by RRT mode.

Keywords

Acute Renal Failure Renal Replacement Therapy Hospital Mortality Continuous Renal Replacement Therapy Intensive Care Unit Mortality 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

La thérapie continue de remplacement rénal améliore la récupération rénale suivant une insuffisance rénale aigu ë

Résumé

Objectif

L’insuffisance rénale aigu ë (IRA) se manifeste chez près de 10 % des grands malades, avec une morbidité et une mortalité accentuées. Le mode optimal de thérapie continue de remplacement rénal (TCRR) reste controversé. Notre étude rétrospective a comparé la TCRR et l’hémodialyse intermittente (HDI) en termes de morbidité et de mortalité à l’unité des soins intensifs (USI) et à l’hôpital de même que la récupération rénale.

Méthode

Pour notre étude rétrospective, nous examiné les dossiers de tous les patients traités par TCRR pour l’IRA au cours de 12 mois. Nous avons comparé les patients selon le mode de TCRR, les caractéristiques démographiques et physiologiques, l’évolution à l’USI, la mortalité à l’hôpital et la récupération rénale en utilisant le test du chi deux et le test t de Student et une régression logistique multiple selon le cas.

Résultats

Pendant la période étudiée, 116 patients atteints d’insuffisance rénale, dont 93 avaient une IRA, ont reçu une TCRR. La sévérité de la maladie des patients sous TCRR était comparable à celle des patients sous HDI d’après le score APACHE II (25,1 vs 23,5, P = 0,37), mais nécessitait des soins infirmiers significativement plus intensifs (échelle d’intervention thérapeutique 47,8 vs 37,6, P = 0,0001). La mortalité était plus fréquente avec un pH plus bas au moment de l’admission (P = 0,003) et avec l’âge (P = 0,03). La récupération rénale était significativement plus fréquente chez les patients traités initialement avec une TCRR (21/24 vs 5/14, P = 0,0003). Une recherche plus poussée visant à définir le moment optimal, la dose et la duré de la TCRR est souhaitable.

Conclusion

La présente recherche indique que la récupération peut être meilleure après une TCRR qu’une HDI pour l’IRA. Le mode de TCRR ne modifie pas significativement la mortalité.

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Copyright information

© Canadian Anesthesiologists 2005

Authors and Affiliations

  • Michael J. Jacka
    • 1
    Email author
  • Xenia Ivancinova
    • 1
  • R. T. Noel Gibney
    • 1
  1. 1.Department of Anesthesiology and the Division of Critical Care MedicineFaculty of Medicine and Dentistry, University of Alberta HospitalsEdmontonCanada

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