Nephrology Critical Care

John S, Eckardt KU. Renal replacement in the ICU. Chest  2007;132:1379-88. Explains the various forms of hemodialysis, ultrafiltration, and hemofiltration. http://www.ncbi.nlm.nih.gov/pubmed/17934125?ordinalpos=7&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Vinsonneau C, Camus C, Combes A, et al. Continuous venovenous haemodiafiltration versus intermittent haemodialysis for acute renal failure in patients with multiple-organ dysfunction syndrome.  Lancet  2006 ; 368 :379-85.  Like previous RCTs addressing this issue, this multicenter study of 360 ICU patients found no advantage to continuous venovenous dialysis in terms of 60-day survival.  A limitation of the study is that the delivered dialysis dose may have been suboptimal for both arms. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16876666&query_hl=7&itool=pubmed_docsum

Palevsky PM, Zhang JH, O’Connor TZ, et al. Intensity of renal support in critically ill patients with acute kidney injury.  N Engl J Med  2008; 359:7-20. The ATN study included 1,124 patients with acute kidney failure requiring dialysis plus failure of 1 other organ system or sepsis. Unlike previous studies, more intensive renal replacement therapy did not improve outcomes, regardless of whether therapy was intermittent or continuous. Of note, the less intensive replacement group still received standard amounts of therapy and required ultrafiltration more often for volume control. http://www.ncbi.nlm.nih.gov/pubmed/18492867?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

Venkataraman R, Kellum JA. Prevention of acute renal failure. Chest 2007; 131:300-8.  This succinct summary of pharmacologic and non-pharmacologic interventions focuses in particular on prevention of contrast nephropathy, including discussions of dopamine, fenoldopam, theophylline, acetylcysteine, and hydration. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17218591&query_hl=35&itool=pubmed_docsum