[Continuous renal replacement therapy for severe acute renal failure].
OBJECTIVE
To estimate the clinical value of continuous renal replacement therapy (CRRT) in the treatment of severe acute renal failure (ARF) and identify the factors influencing the patients' prognosis.


METHODS
The clinical characteristics, disease severity and prognosis were retrospectively studied in 116 patients with severe ARF undergoing CRRT from January, 1998 to May, 2004, in comparison with those in 102 such patients treated with intermittent hemodialysis (IHD).


RESULTS
The mean score of Acute Physiology and Chronic Health Evaluation II (APACHE II) was 27.0+/-7.5 in patients receiving CRRT, of whom 56 (48%) had a score no less than 29, 36 (31%) between 24 to 29 and 24 (21%) less than 24. The mean APACHE II score was 21.9+/-5.2 in patients with IHD, and none of them had a score over 29, 44 (43%) had a score between 24 to 29 and 58 (57%) less than 24. The mean APACHE II score of CRRT group was significantly higher than that of IHD group (t=4.769, P=0.000), suggesting that most of the patients treated with CRRT were in critical condition. The patients' survival rate, however, did not differ significantly between the two groups, being 37% (43/116) in CRRT group and 48/ (49/102) in IHD group (X2=2.678, P=0.101 8). When only the patients with a score no less than 24 were compared, the survival rate of CRRT group was significantly higher than that of IHD group (24% vs 9%, X2=4.229, P=0.039 7), demonstrating better effect of CRRT than IHD in the management of critical ARF cases. In patients treated with CRRT, the patients in fatal cases had significantly older age, more critical condition (indicated by APACHE II score) and greater dependence on mechanical ventilation or vasoactive support than those who survived (P<0.05).


CONCLUSIONS
CRRT is one of the effective methods for management of severe ARF patients, especially in those with critical conditions, with better effect than that of IHD. The prognosis of severe ARF patients treated with CRRT can be influenced by the patients' age and disease severity, and the need of vasoactive drugs or mechanical ventilation may help predict the patients' prognosis.
Shao
Yong-hong
YH
Department of Nephrology, First People's Hospital of Foshan City, Foshan 528000, China. syhong@fsyyy.com
Huang
Ying-wei
YW
Kong
Yao-zhong
YZ
Zhou
Li-xin
LX
Lin
Min-wa
MW
Xiao
Guang-qing
GQ
D058186:Acute Kidney Injury / Q000628:therapy*; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D017582:Renal Replacement Therapy; D012189:Retrospective Studies