Hemofiltration and Peritoneal Dialysis in Infection-Associated Acute Renal Failure in Vietnam

In developing nations, infection-associated acute renal failure is associated with high morbidity and mortality. This open, randomized trial from Vietnam compared peritoneal dialysis, widely used in patients with this condition (with falciparum malaria or sepsis), with hemofiltration. Resolution of acidosis and a decrease in the serum creatinine concentration occurred more than twice as rapidly in the group assigned to hemofiltration, and renal-replacement therapy was required for a shorter period. Survival was improved in the group assigned to hemofiltration. Acute renal failure is a major contributor to the morbidity and mortality associated with severe infection. 1 , 2 The management of acute renal failure in patients with severe sepsis is difficult because of the associated hemodynamic instability and multiorgan dysfunction. In the developed world, both hemodialysis and peritoneal dialysis have been used in the acute phase of renal impairment, though intermittent hemodialysis is complicated by unstable blood pressure. 3 This problem can be avoided by the use of continuous hemofiltration, particularly when a pump is used to ensure constant filtration. 4 , 5 Pumped venovenous hemofiltration, and variants such as hemodiafiltration, have therefore become . . .