Renal failure
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Comparative Study Clinical Trial
A novel method for regional citrate anticoagulation in continuous venovenous hemofiltration (CVVHF).
Continuous renal replacement therapy (CRRT) is increasingly used in managing acute renal failure (ARF) as it offers hemodynamic stability and significant solute clearance in this setting. However, it also requires anticoagulation. Traditionally, heparin has been the anticoagulant of choice but this increases hemorrhagic risk in already high-risk ARF patients. Regional citrate anticoagulation offsets this risk. However, it can be difficult to manipulate regional anticoagulation in CRRT. Moreover, citrate CRRT has been plagued by short optimal filter patency times. ⋯ This novel CVVHF-citrate system achieved excellent clearance and dramatically improved filter patency compared to saline-flush systems. Moreover, it did so with minimal toxicity.
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Comparative Study Clinical Trial
Integration of APACHE II and III scoring systems in extremely high risk patients with acute renal failure treated by dialysis.
Acute physiology, age, chronic health evaluation II and III (APACHE II and III) scoring systems obtained on the day of the initiation of dialysis were compared the mortality rate among in critically ill patients with acute renal failure requiring dialysis. ⋯ Both predictive models demonstrated a similar degree of overall goodness-of-fit. Although APACHE II showed better calibration, APACHE III was better in terms of discrimination. The prediction accuracy of the APACHE II score for extremely high-risk patients is further enhanced by specific utility of APACHE III scoring as a second prediction model when the AII score is 24 or higher.