Shahab Naqvi.
Continuous Renal Replacement therapy for Acute Renal Failure patients in ICU setting: Various techniques and their dynamics.
Pak Armed Forces Med J Jan ;52(2):188-98.

Incidence of acute renal failure (ARF) in post cardiac surgical patients remains high (5 - 18%) and mortality associated with it is still said to be nearer to 80%. But, even this fact does not make renal failure an acceptable cause of death unless a conscious decision has been made not to treat it in the face of another non-recoverable disease. So the message remains that every patient suffering from ARF in an ICU setting MUST be treated aggressively unless DNAR (Do Not Attempt Resuscitation) status has been decided by a team of consultants. Vast majority of the patients suffering from ARF in a post cardiac surgical ICU have low cardiac output syndrome (LCOS). These patients remain on aggressive cardiorespiratory and monitoring support and hence can not be moved to haemodialysis units. At the same time they are unable to tolerate the osmotic and haemodynamic stress of haemodialysis. Thus continuous renal replacement therapies (CRRT) remain the only option available to them. Different types of CRRT are available. The list includes Peritoneal dialysis (PD), slow continuous ultrafiltration (SCUF), Continuous arteriovenous haemofiltration (CAVH), Continuous veno-venous haemofiltration (CVVH), continuous arteriovenous haemodiafiltration (CAVHDF), and continuous veno-venous haemodiafiltration (CVVHDF). Every modality has its own advantages and limitations and should be selected according to requirement of the patient. This is a review article.

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