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New perspectives for prevention/treatment of acute renal failure

Acute renal failure continues to be a difficult clinical problem in critically ill patients, despite advances in critical care and dialysis. This review focuses on some of the current issues in the nondialytic and dialytic management of these patients. Critical analysis of some still frequently used drugs in these patients such as diuretics and dopamine in so-called ‘renal doses’ has revealed little beneficial effect. Recent data are in conflict with previous suggestions that biocompatible membranes have a positive effect on the recovery of renal function and on patient mortality. The choice between intermittent haemodialysis and continuous renal replacement therapy should be made on an individual basis and not on the basis of ‘dogmatic’ opinion.