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1、DialytictherapyinAcuteRenalFailure–startingfromsquareoneDrChanChingKitMedicalOfficerRenalUnit,DepartmentofMedicine,PYNEHOutlineBackgroundanddefinitionsModalitiesofdialytictherapyPracticalproblemsindialytictherapyinARF-5wWhytostart?Whentostart?Whattostart?–I
2、HD/CRRTdilemmaHowtostart?–anticoagulation,choiceofdialyserHowmuchto‘wash’?–soluteandfluidclearanceandadequacyConclusionBackgroundMortalityinpatientswithARFissurprisinglyhigh,andhasnotchangedsignificantlydespiteadvancesinmedicaltechnology/introductionofdialy
3、sisformorethan30years10-23%ofICUpatientdevelopedARFBrivetetal.CritCareMed24:192-198,1996Groneveldetal.Nephron59:602-610,199170%requiredrenalreplacementtherapy(RRT)tosustainlife.McCulloughetal.AmJMed103:368-375,1997PeriodprevalenceofARFonRRTinICUwas5-6%Uchin
4、oetal.JAMA294:813-818,2005BackgroundSepsis+/-MODSasleadingcauseforARFInpatientmortalityfrom~30%innephrotoxicdruginducedARFto>90%whenARFisassociatedwithmultipleorganfailure.Turneyetal.JAMA275:1516-1517Chertowetal.ArchInternMed155:1505-1511,1995BackgroundARFi
5、sanindependentriskfactorformorbidityandmortalityMetnitzetal.CritCareMed30:2051-8,2002UraemicstateandtheneedforRRTamongcriticallyillpatientsfrequentlyresultsintherapy-relatedcomplications,whichmayfurtheraggravatetheunderlyingconditionManagingARFinICUisasigni
6、ficantongoingchallengetoIntensivistsandNephrologists.ACFryetalPostgradMedJ2006;82:106-111DefinitionofARFWidevariationinquotedfiguresduetonoconsensusdefinitionsforARF!Morethan35differentdefinitionshavebeenusedintheliterature,creatingconfusionanddifficultiesi
7、ncomparisonamongdifferentstudies.KellumJAetal.CurrOpinCritCare8:509-514,2002TheAcuteDialysisQualityInitiative(ADQI)Developconsensusandevidence-basedstatementsinthefieldofARFRIFLECriteriaLinearincreaseinoddsratiofromRisktoFailure(Oddsratios,Risk2.5,Injury5.4
8、,Failure10.1)CritCareMed2006:Vol34No7:1913-1917PracticalproblemsindialytictherapyinARFWhytostart?IndicationsforrenalreplacementtherapyinICURenalAcid-basedisturbance–mainlymetabolicacidosisElectrolytesd
