Indication for dialysis influences outcome from acute renal failure (ARF) the ICU; Results from a radomized multicenter trial.
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Sep) 8:144A 1997
0682 This abstract analyzes the outcome, in patients treated for acute renal failure in a study of continuous (CRRT) vs. intermittent (IHD) dialysis therapy, according to the indications for dialytic therapy. The patients are divided into three indication groups--"solute" (BUN > 90, creatinine > 6.0 [either? both?]), "volume" (fluid gain > 4 L and clinical evidence of volume overload), and "combined" (both indications present). Those who began dialysis because of high BUN or creatinine alone had better outcomes than those who developed fluid overload prior to initiation of extracorporeal therapy (ICU mortality for solute group 49%, for volume 56%, for combined 62%).
Comment: Well, what does this mean? It is instructive to look at the 1996 abstract from the same group, which looks at outcome in the same study in IHD vs. CRRT groups. In that analysis, which in contrast to the present report was randomized and prospective, there was 60% mortality with CRRT and 42% with IHD. Nevertheless, when the results were adjusted for age, gender, prevalence of liver failure, APACHE II and APACHE III scores, the groups were finally declared equivalent in outcome. The raw differences in outcome between the groups in the present analysis are even less marked, and while mention is made that "these trends were maintained within each strata of APACHE III," those differences are not striking, and may be explained by confounding factors, such as the cause of ARF (toxic vs. ischemic, etc.). The authors' conclusions are suitably cautious: volume overload may be a contributor to adverse outcome, and this fact should be considered in future studies of ARF in the ICU. I think, that is the whole of the message here: that multivariate models of ARF mortality should perhaps evaluate the indications for dialysis as a contributing factor. (Robert H. Barth, M.D., VA Medical Center, Brooklyn, NY)
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ASN 30th Annual Meeting, San Antonio
Basic hemodialysis : (Intermittent) dialysis for ARF
Other extracorporeal therapies : Continous therapies