Nephrology
-
Acute renal failure (ARF) still bears a poor prognosis with mortality rates up to 70% and the ideal form of renal replacement therapy (RRT) remains controversial. The purpose of this study was to conduct a systematic review and meta-analysis of all randomized controlled trials (RCT) to examine the effect of dialysis modality (IHD: Intermittent haemodialysis; CRRT: continuous renal replacement therapy) on survival of patients with ARF and to also study the effect of each modality on dialysis dependence (DD). ⋯ Similar to previously reported meta-analyses, we did not find a significant effect of CRRT on the OR of survival. The progressive reduction in the OR of survival with CRRT relative to IHD might reflect progressive improvements in IHD. The OR of DD was not affected by mode of RRT. In conclusion, compared with IHD, CRRT does not offer an advantage with regards to survival or DD in ARF. Considering its cost and potential disadvantages, it is imperative to identify the subset of patients with ARF that would potentially derive maximum benefit from CRRT. This will require large, adequately powered studies with sufficient follow-up.
-
The experts have argued about the use of the risk, injury, failure, loss and end-stage renal failure (RIFLE) criteria as a prognosis scoring system. We examined the association between in-hospital mortality and the RIFLE criteria, and discussed its accuracy as a prognosis factor. ⋯ In this population, the risk of in-hospital mortality during the acute kidney injury (AKI) episode was positively associated with RIFLE classes. We showed that the RIFLE classification system had discriminative power in predicting hospital mortality within 60 days in AKI patients, but not better than a specific AKI predictive model. However, a combined use of both may give a more robust prognosis system.