Dialysis prescription and kinetics in acute renal failure

The recognition that both morbidity and mortality are inversely related to delivered hemodialysis (HD) dose in end-stage renal disease (ESRD) patients has substantially changed clinical practices in the United States. A number of quantification techniques, which differ greatly in complexity and sophistication, are now used in ESRD patients. Investigators recently have attempted to extrapolate some of these ESRD quantification methods to the acute renal failure (ARF) setting. This review focuses on these recent attempts. Both patient-related and renal replacement therapy (RRT)-related differences in ESRD and ARF are discussed. In addition, the potential pitfalls of extrapolating certain ESRD quantification methods to RRT in ARF are discussed. Prescription considerations for both intermittent HD (IHD) and continuous RRT (CRRT) are presented. Finally, recent data suggesting survival in critically ill ARF patients is directly correlated with delivered therapy dose are reviewed. The optimal technique for RRT quantification in ARF remains to be determined.