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Acute kidney injury (AKI), previously called acute renal failure (ARF), [1] [2] is a sudden decrease in kidney function that develops within seven days, [3] as shown by an increase in serum creatinine or a decrease in urine output, or both.
Before implementing continuous renal replacement therapy (CRRT), acute renal failure (ARF) in critically ill, multiple organ failure patients was managed by intermittent hemodialysis and the mortality rate was very high. [4] Hemodialysis is effective in clearance and ultrafiltration, but it has deleterious effects on hemodynamic stability. [5]
Acute kidney injuries can be present on top of chronic kidney disease, a condition called acute-on-chronic kidney failure (AoCRF). The acute part of AoCRF may be reversible, and the goal of treatment, as with AKI, is to return the person to baseline kidney function, typically measured by serum creatinine .
Even though it is not a cure for kidney failure, dialysis is a very effective treatment. [21] Survival rates of kidney failure are generally longer with dialysis than without (having only conservative kidney management). However, from the age of 80 and in elderly patients with comorbidities there is no difference in survival between the two groups.
Hemofiltration is sometimes used in combination with hemodialysis, when it is termed hemodiafiltration. Blood is pumped through the blood compartment of a high flux dialyzer, and a high rate of ultrafiltration is used, so there is a high rate of movement of water and solutes from blood to dialysate that must be replaced by substitution fluid that is infused directly into the blood line.
Dialysis can be helpful in the short term but can do only 10% to 15% of what a healthy kidney does, and people on dialysis face a 50% chance of dying in five years after beginning the treatment ...
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