Management of acute renal failure with hemodialysis and peritoneal dialysis

Abstract

Acute renal failure (ARF) is defined as the sudden or rapid onset of loss of normal renal function resulting in the failure of the kidney to excrete nitrogenous waste products and to maintain fluid and electrolyte homeostasis1. The various causes of ARF expressed as a function of prerenal, renal, and postrenal pathophysiology as well as age are listed in several textbooks2,3. The annual incidence of severe ARF warranting dialysis therapy in children (3.7 cases per 100 000 child population)4 is much less than that in adults (17.2 cases per 100 000 adult population)5. However, within the pediatric population the age-related incidence is appreciably higher for the neonate and infant group (19.7 cases per 100 000 neonate/infant age group)4. The causes of ARF are likely to vary with the practice setting and in different parts of the world; however, in the developed countries hemolytic-uremic syndrome (HUS) remains one of the most common primary renal diseases causing ARF4,6. In tertiary care settings and referral centers, ARF occurs more frequently in the setting of a critically ill patient in the intensive care unit and typically follows another organ failure. The incidence of ARF in the pediatric and neonatal intensive care population can be as high as 3-10%7,8. This incidence is likely to be higher now as more children are undergoing increasingly intensive intervention in all the subspecialities. Due to the complexities involved in the care of a child with ARF, these patients should preferably be managed at a specialized pediatric nephrology center that provides 24-h coverage by a pediatric nephrologist, surgeon, urologist, and the supporting dialysis personnel9.