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

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          Abstract

          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.

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          Long-term results of overlapping anterior anal-sphincter repair for obstetric trauma.

          Anterior structural damage to the anal sphincter occurs in up to a third of women at first vaginal delivery, and of these a third have new bowel symptoms. The standard treatment for such structural damage is anterior overlapping anal-sphincter repair. We aimed to assess the long-term results of this operation. We assessed the long-term results in 55 consecutive patients who had had repair a minimum of 5 years (median 77 months [range 60-96]) previously. Questionnaire and telephone interview assessed current bowel function and continence, restriction in activities related to bowel control, and overall satisfaction with the results of surgery. 42 of these patients had been continent of solid and liquid stool at a median of 15 months after the repair. We were able to contact 47 (86%) of the 55 patients. One of these patients had required a proctectomy and end ileostomy for Crohn's disease. Of the remaining 46 patients, 27 reported improved bowel control without the need for further surgery, and 23 rated their symptom improvement as 50% or greater. Seven patients had undergone further surgery for incontinence and one patient had not had a covering stoma closed. Thus, the long-term functional outcome of the sphincter repair alone could be assessed in 38 patients. Of these patients, none was fully continent to both stool and flatus; only four were totally continent to solid and liquid stool; six had no faecal urgency; and eight had no passive soiling. Of the 38 patients, 20 still wore a pad for incontinence and 25 reported lifestyle restriction. 14 reported the onset of a new evacuation disorder after sphincter repair. 23 of the 46 patients contacted had a successful long-term outcome (defined as no further surgery and urge faecal incontinence monthly or less). The results of overlapping sphincter repair for obstetric anal-sphincter damage seem to deteriorate with time. Preoperative counselling should emphasise that although most patients will improve after the procedure, continence is rarely perfect, many have residual symptoms, and some may develop new evacuation disorders.
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            Acute renal failure in intensive care units--Causes, outcome, and prognostic factors of hospital mortality

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              Current Status of Renal Replacement Therapy for Acute Renal Failure

              Although the management of acute renal failure (ARF) constitutes a major component of the activities of practicing nephrologists, minimal information is available on the dialysis techniques utilized to treat ARF in the USA. It is evident from several recent publications that there are wide variations in the dialytic and nondialytic management of ARF. In order to obtain a better understanding of the current practice for dialytic management of ARF, the National Kidney Foundation (NKF) Council on Dialysis commissioned a survey of NKF members. This article describes the results of this survey and provides a snapshot of the current management practices for ARF. It is our hope that this information will provide a baseline for further research in this area.
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                Author and article information

                Journal
                AJN
                Am J Nephrol
                10.1159/issn.0250-8095
                American Journal of Nephrology
                S. Karger AG
                0250-8095
                1421-9670
                2002
                February 2002
                28 March 2002
                : 22
                : 1
                : 29-34
                Affiliations
                Division of Nephrology, Humber River Regional Hospital, University of Toronto, Ont., Canada
                Article
                46671 Am J Nephrol 2002;22:29–34
                10.1159/000046671
                11919400
                © 2002 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 3, References: 20, Pages: 6
                Product
                Self URI (application/pdf): https://www.karger.com/Article/Pdf/46671
                Categories
                Clinical Study

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