To the Editor:
In the excellent special report by Dr. Vincent on evidence-based medicine in the ICU, no mention was made about the beneficial effect of daily hemodialysis (DH) in patients with acute renal failure (ARF). Schiffl and colleagues (1) and Bonventre (2) have demonstrated that a regime of DH was superior to alternate-day hemodialysis (ADH) in this cohort of patients who typically have a high mortality. (1,2) Better uremic control, fewer hypotensive episodes, and more rapid resolution of ARF was noted in the DH group. Notably, among those patients with a normal urinary output at enrollment, 73% in the ADH group and only 21% in the DH group became oliguric. This could be related to the fewer hypotensive episodes in the DH group. Better uremic control and improved volume status could have contributed to the improved survival as well. This study, along with another study by Ronco and colleagues, (3) call for intensive renal replacement therapy in the form of DII or continuous venovenous hemofiltration in all patients in the ICU with ARF.
Boban Thomas, MD, FCCP
Francisco Munoz, MD
Hospital Fernando Fonseca
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal. org/misc/reprints.shtml).
Correspondence to: Boban Thomas, MD, FCCP, Hospital Fernando Fonseca, Av Almirante Gago Coutinho, Lisbon 1700-029, Portugal; e-mail: firstname.lastname@example.org
(1) Schiffl H, Lang SM, Fischer R. Daily hemodialysis and the outcome of acute renal failure. N Engl J Med 2002; 346:305-310
(2) Bonventre JV. Daily hemodialysis: will treatment each day improve the outcome in patients with acute renal failure? N Engl J Med 2002; 346:362-364
(3) Ronco C, Bellomo R, Homel P, et al. Effects of different doses in continuous veno-venous hemofiltration on outcomes of acute renal failure: a prospective randomized trial. Lancet 2000; 356:26-30
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