Renal replacement therapy for acute renal failure

Mortality from acute renal failure (ARF) remains very high and is associated with the development of multisystem failure. Technical developments in haemodialysis machines and dialyser membranes have reduced complications associated with haemodialysis. However, some patients are too unstable to be haemodialysed successfully. Continuous haemofiltration and continuous arterio-venous (or veno-venous) haemodialysis can be performed on Intensive Care Units in hospitals without the availability of a Renal Unit. These techniques provide more effective and controlled removal of fluid and uraemic toxins. There are now few indications for the use of peritoneal dialysis. These new developments have facilitated easier management of the unstable patient with acute renal failure. Whether the prognosis of acute renal failure patients will be improved remains to be determined.