Year in review 2005: Critical Care – nephrology

Zaccaria Ricci,Claudio Ronco

doi:10.1186/cc4998

Abstract

We summarize original research in the field of critical care nephrology accepted or published in 2005 in Critical Care and, when considered relevant or directly linked to this research, in other journals. The articles have been grouped into four categories to facilitate a rapid overview. First, physiopathology, epidemiology and prognosis of acute renal failure (ARF): an extensive review and some observational studies have been performed with the aim of describing aspects of ARF physiopathology, precise epidemiology and long-term outcomes. Second, several authors have performed clinical trials utilizing a potential nephro-protective drug, fenoldopam, with different results. Third, the issue of continuous renal replacement therapies dose has been addressed in a small prospective study and a large observational trial. And fourth, alternative indications to extracorporeal treatment of ARF and systemic inflammatory response syndrome have been explored by three original clinical studies.

Highlights

During 2005, Critical Care accepted and published articles of original research focused on critical care nephrology and renal replacement therapy (RRT)
We present a review of these papers and other key articles on critical care nephrology published in 2005
This extensive analysis introduces a provocative hypothesis in the physiopathology of acute renal failure (ARF): the traditional mechanism of ischemic ARF in critically ill septic patients is put to discussion and, if confirmed by designed experimental and human studies, it could provide new important information about the prevention and therapy of septic ARF

Summary

Introduction

During 2005, Critical Care accepted and published articles of original research focused on critical care nephrology and renal replacement therapy (RRT). The mortality rates remain higher than 50%, despite new approaches to general management, such as advanced monitoring, and despite new available RRT machines and a trend to increased prescription of dialytic dose Another point that should be commented on is the urgent need for a common definition of ARF, an essential instrument in comparing different epidemiological studies and for evaluating therapies during clinical trials [5]. None of them was able to show significant effects on protection from dialysis and mortality These puzzling results must be examined with care: the stage has been set for a large, phase III, multicenter, randomized, placebo-controlled trial to test renal-dose fenoldopam before its routine use in clinical practice. The particular setting of this paper and its initial results, deserve further data collection in order to draw any definitive conclusion

The dose of dialysis

Findings

Alternative indications to extracorporeal treatments