Volume 3 Issue 3, March 2007

The first of this pair of 'pro/con' Viewpoints sets out the case for the superiority of continuous renal replacement therapy over intermittent hemodialysis in critically ill patients with acute kidney injury. Forming the basis of the author's argument is the notion that by attempting to correct in a few minutes physiological derangements that have developed over hours or days, intermittent hemodialysis is aggressive and unphysiological; by contrast, continuous renal replacement therapy corrects derangements gently and slowly, like the native kidneys.

The author of this counterpoint argues that the results of recently published randomized clinical trials call into question the assumption that continuous renal replacement therapy is inherently superior to intermittent hemodialysis for patients in the intensive care unit with severe acute kidney injury. The second half of his article examines why this might be. Has intermittent hemodialysis become safer and more efficacious? Might continuous renal replacement therapy be less safe and/or efficacious than previously thought?

The complex interplay between the multiple pathogenic factors that underlie uremic bleeding syndrome is yet to be fully elucidated. As such, guidelines on management of this complication of chronic renal failure are lacking. Here, data from clinical trials of dialysis, erythropoietin, cryoprecipitate, desmopressin and conjugated estrogens have been used to develop a treatment algorithm. This decision aid is accompanied by answers to questions that commonly arise during management of uremic bleeding.

More widespread use of kidneys from cadavers who have suffered irreversible circulatory arrest has the potential to reduce the shortfall between supply and demand of organs for transplantation. In the Netherlands, kidneys from this source now account for almost 50% of cadaveric-donor renal grafts. Here, Dutch authors review outcomes data from studies of non-heartbeating donation (or donation after cardiac death) and relate their own considerable experience with this form of transplantation.

Epigenetic, or nonheritable, mechanisms that regulate gene expression are potentially reversible. In this short article, authors involved in identification of the chemokine RANTES (CCL5) outline the complex pathways that control its expression and thereby influence movement of immune cells, with a focus on T lymphocytes. Rational design of agents based on this knowledge could have a beneficial impact on various forms of nephritis and nephropathy, transplant rejection and acute renal failure.