Intermittent versus continuous treatment for acute renal failure: where do we stand?

Despite impressive advances in the field of general intensive care and in the techniques available for the treatment of acute renal failure (ARF), particularly the development of continuous renal replacement therapies (CRRT), it is suggested that outcome of ARF patients has remained similar to that observed 2 or more decades ago. This article focuses on the impact of several factors, including the dialysis regimen, on outcome in ARF patients in a recent time period compared with an earlier period to assess whether a change has occurred in the patient population, dialysis regimen, or renal and patient outcome. Critical differences between intermittent hemodialysis (IHD) and CRRT and the authors' preference for continuous venovenous hemofiltration (CWH) are explained. However, using the APACHE II score and more specifically use of the ratio between this score at 2 different time points (ICU admission v time of start of dialysis), the need for an easy-to-use and reliable severity-of-illness score to allow adequate comparison of patient groups or treatment strategies is emphasized. Using data from a recent survey, attention is also given to the implementation of acute dialytic support, particularly CRRT, in the Netherlands.