Diagnosis and treatment of acute renal failure in critical care units

Continuous renal replacement therapy (CRRT) for nonrenal conditions are less well established. The alternative indications include sepsis and other inflammatory syndromes, ARDS, CABG, crush injury, lactic acidosis and chronic renal failure. Critically ill patients with complications of ARF are frequently unable to tolerate hemodynamic and osmotic stress of it. CVVH has several advantages that makes it the ideal choice for complicated critically ill patients with acute renal failure. The high ultrafiltrate production rate in CVVH allows controlling azotemia and volume overload in the hypotensive and high catabolic patient. CVVH is less complex and the hemodialysis has fewer hemodynamic disturbances than intermittent hemodialysis. Based on our experience of treatment of critically ill patients with ARF in the ICU of VA hospital of Buffalo, we recommend CVVH for treatment of ICU patients with ARF. Intermittent hemodialysis is reserved for severe hyperkalemia refractory to medical therapy.