therapeutic options in acute renal failure


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1 : Therapeutic options in ARF Dr Salwa Ibrahim,MD MRCP Cairo University 24/5/07
2 : Incidence Incidence of ARF 50-100 new cases /year/pmp Hospital acquired ARF 2-5% of Admissions 23 % of ICU admissions
3 : ARF in “critically ill patients”, severe CVS, respiratory and metabolic instability, sepsis…multiple organ dysfunction ARF in ICU
4 : Mortality in ARF Liano et al, 1996
5 : Classification system for AKI
6 :
7 : Indications for RRT in critically ill ARF patients
8 : Prophylactic Dx in ARF (traumatic) Conger et al, 1975
9 : RRT MODALITIES
10 : Intermittent Hemodialysis
11 : Peritoneal Dialysis
12 : CCRT 1977, Kramer described CAVH
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16 :
17 :
18 : SCUF
19 : CRRT vs. IHD Ronco C, 2001
20 : Hemodynamics during HD and CVVH
21 : CRRT: Removal of inflammatory mediators De Vriese A, et al 1999
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23 :
24 : 8-12 hours Dialysate flow 100-300 ml/m UFR variable BFR 100-300ml/m SLED/EDD (Hybrid therapy)
25 :
26 : SLED/EDD Beth Israel Medical Center (NY) University of Arkansas for medical services University of California at Davis Medical school hospital, Hannover Middlemore hospital, Auckland University of Parma, Italy
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29 :
30 : Modality IHD vs. CRRTDose of RRTTiming of RRTSeverity of illness
31 :
32 : CRRT vs. IHD in ARF Mehta et al, 1996
33 : CRRT vs. IHD in ARF Sandy et al, 1998
34 : CRRT vs. IHD in ARF Augustine et al, 2004
35 : Effect of severity of illness on mortality in the intermittent hemodialysis and continuous renal replacement therapy groups. Mehta et al, Kidney International, 2001 543 282
36 : CRRT vs. IHD
37 : The Lancet 2006; 368:379-385Continuous VVHDF Vs, IHD for ARF in patients with MODS: a multicentre randomised trial Findings Rate of survival at 60-days did not differ between the groups (32% in the IHD group versus 33% in CRRT group). Vinsonneau C, et al
38 :
39 : www.nature.com/clinicalpractice/neph
40 : DOSE OF RRT
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42 :
43 : Frequent dialysis is required for hypercatabolic patients C BUN 60 mg/dl B BUN 80 mg/dl A BUN 100 mg/dl Clark, WR et al J Am Soc Nephrol 1997
44 :
45 : Timing Of Initiation of RRT
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48 : Summary Overall prognosis is poor in MODS Mortality linked to number of failing organs 2 organs….60% mortality 3 organs….92%mortality Uncertainty about the best modality
49 : Summary Treatment should be individualized Patient factors (catabolic state, hemodynamics) Hospital facilities, knowledge and training of nursing staff, cost
50 : Thank You

 

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