Quelles techniques pour le traitement de la défaillance rénale aiguë en réanimation ?

Almost 5% of ICU patients will require extrarenal therapy to treat acute renal failure. The description of continuous venovenous methods in early eighties was responsible for a widespread use in ICU. This method was easy to use for most intensivists and nurses without a long training and was associated with a good hemodynamic tolerance in unstable patients, in contrast with intermittent methods. Whether hemofiltration offered any advantage compared to hemodialysis remained controversial. Indeed most available studies were retrospective with a poor methodological quality precluding any conclusion. The last 10 years have provided an abundant literature to report improvement in extrarenal therapies especially for intermittent hemodialysis regarding efficiency and tolerance. Nowadays, six prospective randomised studies enrolling more than 1000 patients, have been published to report similar outcome for mortality or renal recovery with continuous and intermittent methods in acutely ill-patients. Most experts in this field seem to agree that both are equivalent. Then the experience of the ICU team and the availability of the method should drive the choice of the treatment. The knowledge of advantages and limit of each method may although allow to adapt more specifically the modality based on the indication and its necessity.