Current Canadian Approaches to Dialysis for Acute Renal Failure in the ICU

Background: Although there is a very high mortality rate (>50%) with acute renal failure (ARF) in the intensive care unit (ICU), there is no general consensus on the best dialysis treatment for this condition. Methods: We surveyed by mail questionnaire, all adult academic and community registered Canadian nephrology centers that offer treatment for ARF. Results: The overall response rate was 59% (53/90). Comparing current dialysis methods with those utilized 5 years ago, the largest increase was in continuous renal replacement therapies (CRRT) (26 vs. 9%). Both intermittent hemodialysis (IHD) and peritoneal dialysis decreased in utilization. The predominant current CRRT methods utilized venovenous access (80%), as compared to 5 years ago when arteriovenous was the most common (52%). Despite data from chronic dialysis (and preliminary data in ARF) suggesting reduced mortality and morbidity with increasing dialysis dose, there was no formal method of dialysis prescription monitoring in over 75% of the centers. Conclusion: Notwithstanding a lack of definitive evidence of superior outcomes with CRRT compared to older methods, the utilization of CRRT is dramatically increasing for the treatment of ARF in Canada. Whether this shift towards CRRT, and whether more attention to dialysis dose in ARF, might be expected to lead to better outcomes, requires further evaluation.