Original Article
Effect of the Dialysis Membrane in the Treatment of Patients with Acute Renal Failure
N Engl J Med 1994; 331:1338-1342November 17, 1994
- Abstract
Background
The mortality rate among patients with acute renal failure remains high, and the role of the biocompatibility of the dialysis membrane in the resolution of this disorder is not known.
Methods
We prospectively studied 72 patients with acute renal failure who required hemodialysis and assigned them to two treatment groups. One group underwent dialysis with the widely used cuprophane dialysis membrane, which activates the complement system and leukocytes, and the other group underwent dialysis with a synthetic polymethyl methacrylate membrane, which has a more limited effect on complement and leukocytes. Scores on the Acute Physiology, Age, and Chronic Health Evaluation (APACHE II) were calculated at the initiation of dialysis. Survival and the recovery of renal function were determined with the use of proportional-hazards and exact logistic-regression analyses.
Results
When dialysis was initiated, the patients in the two groups were similar in terms of age, APACHE II scores, the prevalence of oliguria, and biochemical indexes of renal failure. Twenty-three of the 37 patients (62 percent) in the group undergoing dialysis with the polymethyl methacrylate membrane recovered renal function, as compared with 13 of the 35 patients (37 percent) in the group undergoing dialysis with the cuprophane membrane (P = 0.04 after adjustment for the APACHE II score). The median number of dialysis treatments required before the recovery of renal function was 5 in the former group and 17 in the latter group (P = 0.02). Twenty-one patients (57 percent) undergoing dialysis with the polymethyl methacrylate membrane survived, as compared with 13 patients (37 percent) undergoing dialysis with the cuprophane membrane (P = 0.11). Of the 20 patients in each group who initially had nonoliguric acute renal failure, the survival rates were 80 percent with the polymethyl methacrylate membrane and 40 percent with the cuprophane membrane (P = 0.01).
Conclusions
Among patients with acute renal failure requiring hemodialysis, the use of the polymethyl methacrylate membrane, as compared with the cuprophane membrane, resulted in improved recovery of renal function.
Media in This Article
Figure 1
Recovery of Renal Function in Patients with Acute Renal Failure Undergoing Dialysis with a Polymethyl Methacrylate or Cuprophane Membrane, According to the Number of Hemodialysis Treatments.Figure 2
Survival of Patients with Acute Renal Failure Undergoing Dialysis with a Polymethyl Methacrylate or Cuprophane Membrane.Article Activity
- Article
The mortality rate among patients with acute renal failure remains high, ranging from 42 to 75 percent, despite numerous advances in the diagnosis and treatment of this disorder1-4. Several concurrent conditions, such as coma or dependence on a respirator, increase the risk of death in patients with acute renal failure, and the high prevalence of these conditions may explain the persistently high mortality rate5.
The mortality rate is higher among patients with acute renal failure who undergo hemodialysis than among those who do not need such treatment6-9. Different methods of dialysis and the biocompatibility of the dialysis membrane -- defined as the extent of complement and neutrophil activation -- influence the effectiveness of the treatment10. Recent studies in animals indicate that the recovery from acute renal failure is influenced by the degree of leukocyte infiltration in the kidney and by the complement-activating potential of the dialysis membrane to which the animal is exposed11-13.
We undertook a prospective comparison of the influence of dialysis membranes with different degrees of biocompatibility on the recovery of renal function and survival in patients with acute renal failure requiring hemodialysis. We used two membranes: a cellulose membrane made from cotton fibers (cuprophane) that is widely used in the treatment of renal failure and is known to activate complement and neutrophils, and a synthetic membrane (polymethyl methacrylate) associated with more limited complement and neutrophil activation.
Methods
Study Design
All patients over 18 years of age who were hospitalized at Vanderbilt University Medical Center and required hemodialysis for acute renal failure were eligible for enrollment in the study. The study was approved by the institutional review board, and informed consent was obtained from the patients or their next of kin. Patients were excluded from the study if they had undergone renal transplantation or had documented prior chronic renal failure or if they required only ultrafiltration for fluid overload. No patients were excluded on the basis of the cause of acute renal failure, biochemical values, or the presence of concurrent conditions. All decisions regarding the initiation and discontinuation of dialysis were made by the attending nephrologists without consultation with the investigators or knowledge of the membrane to be used.
Once a decision had been made to initiate hemodialysis, the patient was assigned to treatment with one of the two types of membranes, which was then used for all subsequent dialysis treatments. All eligible patients were enrolled in the order that they had presented for treatment, and the assignments to the two treatment groups were made in alternating order. We used a polymethyl methacrylate membrane (Toray B2-1.5H Filtryzer, Toray Industries, Tokyo, Japan) as the biocompatible membrane and a cuprophane membrane (F-120, National Medical Care, Rockleigh, N.J.) as the bioincompatible membrane. The two membranes have hollow fibers and similar clearance and ultrafiltration characteristics, with an ultrafiltration coefficient under 5 ml per millimeter of mercury per hour. Both membranes have been approved by the Food and Drug Administration and are available commercially. The membranes were not reused. The polymethyl methacrylate membrane costs approximately $25, and the cuprophane dialyzer costs $11. All treatments were performed with a volumetric-control machine that allowed precise ultrafiltration.
Patients' Characteristics
A total of 83 patients requiring hemodialysis were enrolled in the study. Nine patients were excluded after they had been assigned to a treatment group because they did not have acute renal failure. Two of these patients were excluded because of the institution of continuous therapy for fluid overload, two had documented prior chronic renal failure, and five required only ultrafiltration for fluid overload. Two other patients underwent dialysis with the wrong membrane on at least one occasion through inadvertent errors. These two patients were also excluded from the study. All 11 patients were excluded before their outcome was known and before the results were analyzed.
Measurement of Severity of Illness
The severity of illness in each patient was determined according to the score on the Acute Physiology, Age, and Chronic Health Evaluation (APACHE II)14 on the first day of dialysis. This score is the sum of the scores for the patient's current physiologic condition, age, and previous chronic conditions. The current-physiology score measures the degree of acute illness and is the sum of the scores assigned to the most abnormal physiologic values for each of 12 variables: temperature, mean arterial pressure, heart rate, respiratory rate, oxygenation, arterial pH, serum sodium, serum potassium, serum creatinine, hematocrit, white-cell count, and score on the Glasgow Coma Scale. Summed together, these three components (current-physiology score, age points, and chronic-conditions score) give a total APACHE II score ranging from 0 to 71. A high APACHE score correlates with severe acute illness and a high risk of mortality14-16.
Outcome Measurements
Outcome measures included survival, the recovery of renal function (defined as the discontinuation of dialysis because it was no longer required), the number of dialysis treatments given, the number of days from the first dialysis treatment to death or the recovery of renal function, and the incidence of oliguria (defined as urinary output ≤ 400 ml per 24 hours) both before and during hemodialysis.
Statistical Analysis
Two methods (the unpaired t-test and the equivalent nonparametric test, the Wilcoxon rank-sum test) were used to compare continuous variables, and Fisher's exact test was used to compare discrete variables between the two groups at the start of treatment with dialysis.
Differences in outcome between the two groups were assessed with Fisher's exact test. An exact logistic-regression analysis, performed with LogXact-Turbo (Cytel Software, Cambridge, Mass.), was used to make an adjustment for the APACHE II score. The time from the initiation of dialysis to recovery or death was analyzed with a proportional-hazards model. All analyses were two-tailed. P values less than 0.05 were considered to indicate statistical significance.
An interim analysis of the data was performed after 40 patients had been enrolled, for presentation at a conference. No other interim analyses were performed. The interim and final analyses were performed with the same statistical methods.
Results
The demographic and clinical characteristics of the patients and the primary causes of their renal failure are shown in Table 1Table 1
Characteristics of the Patients at the Time of Initiation of Hemodialysis.. There were no significant differences between the two groups in terms of age, sex, race, or cause of acute renal failure. There were also no significant differences in the initial APACHE II score or any of its components, the presence of oliguria (a known indicator of a poor prognosis),3,5,9,17,18 or biochemical and nutritional values19 at the initiation of dialysis.The outcome is shown in Table 2Table 2
Outcomes of Hemodialysis in Patients with Acute Renal Failure, According to the Type of Membrane Used. according to the type of membrane used for dialysis and the presence or absence of oliguria at the initiation of dialysis. Of the 37 patients undergoing dialysis with the polymethyl methacrylate (biocompatible) membrane, 23 (62 percent) recovered renal function, as compared with 13 (37 percent) of the 35 patients who underwent dialysis with the cuprophane (bioincompatible) membrane (P = 0.04 after adjustment for the base-line APACHE II score; P = 0.06 before adjustment). The odds ratio for the recovery of renal function with the polymethyl methacrylate membrane, as compared with the cuprophane membrane, was 3.5 (95 percent confidence interval, 1.1 to 12.4).After adjustment for the APACHE II score with proportional-hazards regression analysis, the time from the initiation of dialysis to the recovery of renal function was significantly shorter among the patients undergoing dialysis with the polymethyl methacrylate membrane than among those undergoing dialysis with the cuprophane membrane, in terms of both the number of hemodialysis treatments (Figure 1Figure 1
Recovery of Renal Function in Patients with Acute Renal Failure Undergoing Dialysis with a Polymethyl Methacrylate or Cuprophane Membrane, According to the Number of Hemodialysis Treatments.) and the duration of hemodialysis (P = 0.02 for both). The median number of dialysis treatments needed for the recovery of renal function was 5 (duration, 11 days) among the patients undergoing dialysis with the polymethyl methacrylate membrane and 17 (duration, 33 days) among those undergoing dialysis with the cuprophane membrane.Twenty-one patients (57 percent) in the group undergoing dialysis with the polymethyl methacrylate membrane survived, as compared with 13 (37 percent) in the group undergoing dialysis with the cuprophane membrane (P = 0.11) (Table 2, Figure 2Figure 2
Survival of Patients with Acute Renal Failure Undergoing Dialysis with a Polymethyl Methacrylate or Cuprophane Membrane.). Patients in the former group survived longer after the start of dialysis (median survival, >84 vs. 22 days) (P = 0.3).Forty patients (20 in each group) had nonoliguric acute renal failure at the time dialysis was initiated. Oliguria developed in 15 of the 20 patients (75 percent) undergoing dialysis with the cuprophane membrane and in 8 (40 percent) of those undergoing dialysis with the polymethyl methacrylate membrane (P = 0.047 after adjustment for the APACHE II score). In the group of patients who did not have oliguria before dialysis, the patients undergoing dialysis with the polymethyl methacrylate membrane did better than those undergoing dialysis with the cuprophane membrane, with respect to the recovery of renal function (P = 0.003), survival (P = 0.01), and the median number of dialysis treatments needed for recovery (3 vs. 17 treatments, P<0.05). Among the patients who had oliguria before the initiation of dialysis, the recovery of renal function and survival did not differ significantly between the two treatment groups.
Hypotension, defined as a decrease in mean arterial pressure of at least 20 mm Hg, occurred at least once during 30 percent of the treatments with the polymethyl methacrylate membrane and during 28 percent of those with the cuprophane membrane (P = 0.46).
Among the patients who recovered renal function, the mean (±SD) interval between the last session of dialysis and discharge or death was 26 ±25 days for those undergoing dialysis with the polymethyl methacrylate membrane and 21 ±17 days for those undergoing dialysis with the cuprophane membrane (P = 0.72). None of the patients who recovered renal function required a reinitiation of dialysis.
Discussion
These results suggest that the use of a biocompatible dialysis membrane (polymethyl methacrylate) increased the likelihood that renal function would recover and resulted in some improvement in the survival of patients with acute renal failure. These effects were particularly evident in the patients who did not have oliguria at the start of hemodialysis.
A role for the effect of the biocompatibility of the dialysis membrane on the outcome of dialysis is supported by several studies of the role of activated neutrophils in animals with acute renal injury. These studies have shown the adverse effects of infiltrating leukocytes on the recovery of renal function12,13,20 and on the whole-kidney glomerular filtration rate when activated neutrophils are infused into a mildly ischemic kidney21. In studies of rats with acute renal failure, we found that dialysis with a membrane that activated complement and neutrophils led to a slower resolution of renal failure and was associated with a threefold increase in the number of neutrophils per glomerulus in histologic sections, as compared with the results of dialysis with a membrane that did not activate complement11.
A recently published report compares the outcome in two groups of patients with acute renal failure, one undergoing dialysis with a cuprophane membrane and the other with a polyacrylonitrile (biocompatible, high-flux) membrane22. The rate of mortality, particularly from sepsis, and the course of renal dysfunction were less severe in the group undergoing dialysis with the polyacrylonitrile membrane. However, it is not clear whether this difference in outcome was due to a difference in the flux or the biocompatibility of the two membranes used. The results of our study point to the importance of the biocompatibility of the dialysis membrane.
The activation of complement and neutrophils and the delay in the recovery of renal function can occur through several pathways10. Complement-activation products have direct and indirect vasoconstrictive properties23. In addition, activated neutrophils secrete several vasoconstrictive compounds that can exacerbate ischemia, particularly in the medullary region of the kidney, which is especially susceptible to ischemic insults because of the low oxygen tension in that region24,25. The products of activated complement, as well as those of activated neutrophils, may interact with glomerular endothelial cells and lead to inhibited secretion of the endothelium-derived relaxing factor nitric oxide26. In addition, reactive oxygen radicals, also products of neutrophil activation, have deleterious effects on tubular and glomerular cells27. A recent study documented the release of reactive oxygen radicals during dialysis with complement-activating membranes but not with a non-complement-activating membrane28.
The difference in effect of the biocompatibility of the dialysis membrane according to the presence or absence of oliguria in patients with acute renal failure is also consistent with this proposed pathophysiologic process. Renal blood flow is generally higher in patients with nonoliguric acute renal failure,29 and their kidneys are likely to be perfused with higher concentrations of complement- and neutrophil-activation products.
It has been suggested that dialysis itself may prolong the course of acute renal failure30. The proposed pathophysiologic basis of this effect is the lack of autoregulation of blood flow to the ischemic kidney, so that hypotension, which is sometimes induced during dialysis, results in further ischemia31. In our study, however, the frequency of hypotension during dialysis was low and similar in the two patient groups. Nevertheless, the occurrence of hypotension and the activation of complement and neutrophils by a specific dialysis membrane are not mutually exclusive and may be additive phenomena32.
In summary, the biocompatibility of the dialysis membrane may be an important factor in the recovery from acute renal failure, particularly among patients without oliguria at the initiation of dialysis. The use of a biocompatible membrane may also slow the rate of loss of residual renal function in patients undergoing long-term hemodialysis33. Although the biocompatible membrane we used costs more than the cuprophane membrane, the difference is marginal as compared with the difference in the total cost of treatment.
Supported in part by a grant (1R01-HL-36015-9) from the National Institutes of Health.
We are indebted to the patients and the nursing staff of the dialysis unit at Vanderbilt University Medical Center and to Valerie McSterling for assistance in the preparation of the manuscript.
Source Information
From the Department of Medicine, Division of Nephrology (R.M.H., R.L.W.), and the Department of Preventive Medicine, Division of Biostatistics (R.A.P.), Vanderbilt University Medical Center, Nashville.
Address reprint requests to Dr. Hakim at S-3307 MCN, 1161 21st Ave. S. and Garland, Nashville, TN 37232-2372.
- References
References
1
Woodrow G ,Turney JH . Cause of death in acute renal failure. Nephrol Dial Transplant 1992;7:230-234
Web of Science | Medline2
Bullock ML ,Umen AJ ,Finkelstein M ,Keane WF . The assessment of risk factors in 462 patients with acute renal failure. Am J Kidney Dis 1985;5:97-103
Web of Science | Medline3
Corwin HL ,Teplick RS ,Schreiber MJ ,Fang LS ,Bonventre JV ,Coggins CH . Prediction of outcome in acute renal failure. Am J Nephrol 1987;7:8-12
CrossRef | Web of Science | Medline4
Chew SL ,Lins RL ,Daelemans R ,De Broe ME . Outcome in acute renal failure. Nephrol Dial Transplant 1993;8:101-107
Web of Science | Medline5
Liano F ,Garcia-Martin F ,Gallego A , et al. Easy and early prognosis in acute tubular necrosis: a forward analysis of 228 cases. Nephron 1989;51:307-313
CrossRef | Medline6
Spiegel DM ,Ullian ME ,Zerbe GO ,Berl T . Determinants of survival and recovery in acute renal failure patients dialyzed in intensive-care units. Am J Nephrol 1991;11:44-47
CrossRef | Web of Science | Medline7
Cioffi WG ,Ashikaga T ,Gamelli RL . Probability of surviving postoperative acute renal failure: development of a prognostic index. Ann Surg 1984;200:205-211
CrossRef | Web of Science | Medline8
Lien J ,Chan V . Risk factors influencing survival in acute renal failure treated by hemodialysis. Arch Intern Med 1985;145:2067-2069
CrossRef | Web of Science | Medline9
Maher ER ,Robinson KN ,Scoble JE , et al. Prognosis of critically-ill patients with acute renal failure: APACHE II score and other predictive factors. Q J Med 1989;72:857-866
Web of Science | Medline10
Hakim RM . Clinical implications of hemodialysis membrane biocompatibility. Kidney Int 1993;44:484-494
CrossRef | Web of Science | Medline11
Schulman G ,Fogo A ,Gung A ,Badr K ,Hakim R . Complement activation retards resolution of acute ischemic renal failure in the rat. Kidney Int 1991;40:1069-1074
CrossRef | Web of Science | Medline12
Harris KP ,Schreiner GF ,Klahr S . Effect of leukocyte depletion on the function of the postobstructed kidney in the rat. Kidney Int 1989;36:210-215
CrossRef | Web of Science | Medline13
Badr KF ,Schreiner GF ,Wasserman M ,Ichikawa I . Preservation of the glomerular capillary ultrafiltration coefficient during rat nephrotoxic serum nephritis by a specific leukotriene D receptor antagonist. J Clin Invest 1988;81:1702-1709
CrossRef | Web of Science | Medline14
Knaus WA ,Draper EA ,Wagner DP ,Zimmerman JE . APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818-829
CrossRef | Web of Science | Medline15
Turney JH . Why is mortality persistently high in acute renal failure? Lancet 1990;335:971-971
CrossRef | Web of Science | Medline16
Bartlett RH ,Mault JR ,Dechert RE ,Palmer J ,Swartz RD ,Port FK . Continuous arteriovenous hemofiltration: improved survival in surgical acute renal failure? Surgery 1986;100:400-408
Web of Science | Medline17
Rasmussen HH ,Pitt EA ,Ibels LS ,McNeil DR . Prediction of outcome in acute renal failure by discriminant analysis of clinical variables. Arch Intern Med 1985;145:2015-2018
CrossRef | Web of Science | Medline18
Menashe PI ,Ross SA ,Gottlieb JE . Acquired renal insufficiency in critically ill patients. Crit Care Med 1988;16:1106-1109
CrossRef | Web of Science | Medline19
Lowrie EG ,Lew NL . Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis 1990;15:458-482
Web of Science | Medline20
Yoshioka T ,Ichikawa I . Glomerular dysfunction induced by polymorphonuclear leukocyte-derived oxygen species. Am J Physiol 1989;257:F53-F59
Web of Science | Medline21
Linas SL ,Whittenburg D ,Parsons PE ,Repine JE . Mild renal ischemia activates primed neutrophils to cause acute renal failure. Kidney Int 1992;42:610-616
CrossRef | Web of Science | Medline22
Schiffl H ,Lang SM ,Konig A ,Strasser T ,Haider MC ,Held E . Biocompatible membranes in acute renal failure: prospective case-controlled study. Lancet 1994;344:570-572
CrossRef | Web of Science | Medline23
Cheung AK ,LeWinter M ,Chenoweth DE ,Lew WY ,Henderson LW . Cardiopulmonary effects of cuprophane-activated plasma in the swine. Kidney Int 1986;29:799-806
CrossRef | Web of Science | Medline24
Strasser T ,Schiffl H . Generation of leukotriene B by hemodialyzer membranes: a novel index of biocompatibility. Klin Wochenschr 1991;69:808-812
CrossRef | Medline25
Brezis M ,Epstein FH . Cellular mechanisms of acute ischemic injury in the kidney. Annu Rev Med 1993;44:27-37
CrossRef | Web of Science | Medline26
Brezis M ,Heyman SN ,Dinour D ,Epstein FH ,Rosen S . Role of nitric oxide in renal medullary oxygenation: studies in isolated and intact rat kidneys. J Clin Invest 1991;88:390-395
CrossRef | Web of Science | Medline27
Fischereder M ,Trick W ,Nath KA . Therapeutic strategies in the prevention of acute renal failure. Semin Nephrol 1994;14:41-52
Web of Science | Medline28
Himmelfarb J ,Ault KA ,Holbrook D ,Leeber D ,Hakim RM . Intradialytic granulocyte reactive oxygen species production: a prospective, crossover trial. J Am Soc Nephrol 1993;4:178-186
Web of Science | Medline29
Myers BD ,Moran SM . Hemodynamically mediated acute renal failure. N Engl J Med 1986;314:97-105
Full Text | Web of Science | Medline30
Conger J . Does hemodialysis delay recovery from acute renal failure? Semin Dial 1990;3:146-148
CrossRef | Web of Science31
Conger JD ,Robinette JB ,Hammond WS . Differences in vascular reactivity in models of ischemic acute renal failure. Kidney Int 1991;39:1087-1097
CrossRef | Web of Science | Medline32
Davenport A ,Davison AM ,Will EJ . Membrane biocompatibility: effects on cardiovascular stability in patients on hemofiltration. Kidney Int Suppl 1993;43:S230-S234
CrossRef33
McCarthy JT . The use of polysulfone dialyzers slows the rate of intrinsic renal function loss in chronic hemodialysis patients. J Am Soc Nephrol 1993;4:367-367 abstract.
- Citing Articles (121)
Citing Articles
1
Takaya Abe, Karen Kato, Tomoaki Fujioka, Tadao Akizawa. (2011) The Blood Compatibilities of Blood Purification Membranes and Other Materials Developed in Japan. International Journal of Biomaterials 2011, 1-9
CrossRef2
Andrew Lewington, Suren Kanagasundaram. (2011) Renal Association Clinical Practice Guidelines on Acute Kidney Injury. Nephron Clinical Practice 118:s1, c349-c390
CrossRef3
Savas Ozturk, Rumeyza Kazancioglu, Gulizar Manga Sahin, Aydın Turkmen, Meltem Gursu, Mehmet Sukru Sever. (2009) The Effect of the Type of Membrane on Intradialytic Complications and Mortality in Crush Syndrome. Renal Failure 31:8, 655-661
CrossRef4
V. Chhor, D. Journois. (2009) Emofiltrazione. EMC - Anestesia-Rianimazione 14:4, 1-12
CrossRef5
Philip S. Barie, Lynn J. Hydo, Jian Shou, Soumitra R. Eachempati. (2008) Decreasing Magnitude of Multiple Organ Dysfunction Syndrome Despite Increasingly Severe Critical Surgical Illness: A 17-Year Longitudinal Study. The Journal of Trauma: Injury, Infection, and Critical Care 65:6, 1227-1235
CrossRef6
Hugh T. Davies, Gavin D. Leslie. (2008) Intermittent versus Continuous Renal Replacement Therapy: A matter of controversy. Intensive and Critical Care Nursing 24:5, 269-285
CrossRef7
Alvaro Alonso, Joseph Lau, Bertrand L Jaber, Bertrand L Jaber. 2008. Biocompatible hemodialysis membranes for acute renal failure. .
CrossRef8
Ravinder K. Wali, Jay R. Kaluvapalle, Alfred K. Cheung. 2008. Complications Associated with Hemodialysis. , 894-912.
CrossRef9
René Robert. 2008. Membranes de dialyse. , 30-37.
CrossRef10
Avi Dor, Mark V. Pauly, Margaret A. Eichleay, Philip J. Held. (2007) End-stage renal disease and economic incentives: the International Study of Health Care Organization and Financing (ISHCOF). International Journal of Health Care Finance and Economics 7:2-3, 73-111
CrossRef11
Shigehiko Uchino, Rinaldo Bellomo, Hiroshi Morimatsu, Stanislao Morgera, Miet Schetz, Ian Tan, Catherine Bouman, Ettiene Macedo, Noel Gibney, Ashita Tolwani, Heleen Oudemans-van Straaten, Claudio Ronco, John A. Kellum. (2007) Continuous renal replacement therapy: A worldwide practice survey. Intensive Care Medicine 33:9, 1563-1570
CrossRef12
Sean M Bagshaw. (2007) Epidemiology of renal recovery after acute renal failure. Current Opinion in Internal Medicine 6:1, 31-37
CrossRef13
Peter Schnuelle, Fokko Johannes van der Woude. (2006) Perioperative fluid management in renal transplantation: a narrative review of the literature. Transplant International 19:12, 947-959
CrossRef14
K.J. Kelly. (2006) Acute Renal Failure: Much More Than a Kidney Disease. Seminars in Nephrology 26:2, 105-113
CrossRef15
Paul M Palevsky, Ian Baldwin, Andrew Davenport, Stuart Goldstein, Emil Paganini. (2005) Renal replacement therapy and the kidney: minimizing the impact of renal replacement therapy on recovery of acute renal failure. Current Opinion in Critical Care 11:6, 548-554
CrossRef16
T. Alp Ikizler, Gerald Schulman. (2005) Hemodialysis: Techniques and Prescription. American Journal of Kidney Diseases 46:5, 976-981
CrossRef17
D. E. Uehlinger. (2005) Comparison of continuous and intermittent renal replacement therapy for acute renal failure. Nephrology Dialysis Transplantation 20:8, 1630-1637
CrossRef18
A Alonso, J Lau, BL Jaber, Bertrand Jaber. 2005. Biocompatible hemodialysis membranes for acute renal failure. .
CrossRef19
F. Gueler, W. Gwinner, C. Schiborr, M. Martin, A. Klos, T. Kirsch, A. Fiebeler, H. Haller, D. Fliser. (2005) Biocompatibility Parameters of Different Dialysis Membranes Assessed during Systemic Inflammation. Blood Purification 23:3, 196-202
CrossRef20
Yoh Hirayama, Hiroyuki Hirasawa, Shigeto Oda, Hidetoshi Shiga, Kazuya Nakanishi, Kenichi Matsuda, Masataka Nakamura, Takeshi Hirano, Takeshi Moriguchi, Eizo Watanabe, Masakazu Nitta, Ryuzo Abe, Takaaki Nakada. (2003) The Change in Renal Replacement Therapy on Acute Renal Failure in a General Intensive Care Unit in a University Hospital and its Clinical Efficacy: A Japanese Experience. Therapeutic Apheresis and Dialysis 7:5, 475-482
CrossRef21
N MAXVOLD, T BUNCHMAN. (2003) Renal failure and renal replacement therapy. Critical Care Clinics 19:3, 563-575
CrossRef22
Ravindra L Mehta. (2003) Outcomes research in acute renal failure. Seminars in Nephrology 23:3, 283-294
CrossRef23
Paul Carmichael, Amtul R. Carmichael. (2003) Acute renal failure in the surgical setting. ANZ Journal of Surgery 73:3, 144-153
CrossRef24
Matthias Brause, A. Neumann, T. Schumacher, B. Grabensee, Peter Heering. (2003) Effect of filtration volume of continuous venovenous hemofiltration in the treatment of patients with acute renal failure in intensive care units. Critical Care Medicine 31:3, 841-846
CrossRef25
Paul Scheel, Joseph Eustace, Hamid Rabb. (2003) Continuous dialysis as systemic therapy in the critically ill patient? *. Critical Care Medicine 31:3, 988-989
CrossRef26
Sanjay Subramanian, Ramesh Venkataraman, John A Kellum. (2002) Influence of dialysis membranes on outcomes in acute renal failure: A meta-analysis. Kidney International 62:5, 1819-1823
CrossRef27
Michael J. Morykwas, Hampton Howell, Anthony J. Bleyer, Joseph A. Molnar, Louis C. Argenta. (2002) The Effect of Externally Applied Subatmospheric Pressure on Serum Myoglobin Levels after a Prolonged Crush/Ischemia Injury. The Journal of Trauma: Injury, Infection, and Critical Care 53:3, 537-540
CrossRef28
F. Gores, P. Montag, C. Schall, J. Vienken, S.K. Bowry. (2002) Verification of the chemical composition and specifications of haemodialysis membranes by NMR and GPC-FTIR-coupled spectroscopy. Biomaterials 23:15, 3131-3140
CrossRef29
Sharon Phillips Andreoli. (2002) Acute renal failure. Current Opinion in Pediatrics 14:2, 183-188
CrossRef30
A BRIGLIA. (2002) Hepatorenal syndromeDefinition, pathophysiology, and intervention. Critical Care Clinics 18:2, 345-373
CrossRef31
Nele Van de Noortgate, Francis Verbeke, Annemieke Dhondt, Francis Colardijn, Wim Van Biesen, Raymond Vanholder, Norbert Lameire. (2002) The Dialytic Management of Acute Renal Failure in the Elderly. Seminars in Dialysis 15:2, 127-132
CrossRef32
Nestor Schor. (2002) Acute renal failure and the sepsis syndrome. Kidney International 61:2, 764-776
CrossRef33
Joerg Vienken, Sudhir Bowry. (2002) Quo vadis Dialysis Membrane?. Artificial Organs 26:2, 152-159
CrossRef34
Georg Engelich, Daniel G. Wright, Kevan L. Hartshorn. (2001) Acquired Disorders of Phagocyte Function Complicating Medical and Surgical Illnesses. Clinical Infectious Diseases 33:12, 2040-2048
CrossRef35
Jadranka Buturovic Ponikvar, Rina R. Rus, Rajko B. Kenda, Andrej F. Bren, Rafael R. Ponikvar. (2001) Low-Flux Versus High-Flux Synthetic Dialysis Membrane in Acute Renal Failure: Prospective Randomized Study. Artificial Organs 25:12, 946-950
CrossRef36
Gopesh K. Modi, Brian J. G. Pereira, Bertrand L. Jaber. (2001) Hemodialysis in Acute Renal Failure: Does the Membrane Matter?. Seminars in Dialysis 14:5, 318-321
CrossRef37
M KAPOOR, G CHAN. (2001) MALIGNANCY AND RENAL DISEASE. Critical Care Clinics 17:3, 571-598
CrossRef38
R Vanholder, N Lameire. (2001) Acute renal failure: future directions for research. Nephrology 6:2, 57-61
CrossRef39
Ali Al-Khafaji, Howard L. Corwin. (2001) Acute Rental Failure and Dialysis in the Chronically Critically Ill Patient. Clinics in Chest Medicine 22:1, 165-174
CrossRef40
Paul Bent, Han Khim Tan, Rinaldo Bellomo, Jonathan Buckmaster, Laurie Doolan, Graeme Hart, William Silvester, Geoffrey Gutteridge, George Matalanis, Jai Raman, Alexander Rosalion, Brian F Buxton. (2001) Early and intensive continuous hemofiltration for severe renal failure after cardiac surgery. The Annals of Thoracic Surgery 71:3, 832-837
CrossRef41
Vladimir Gašparović, Kristina Đaković, Marijan Merkler, Nina Gubarev, Zoran Pišl, Dragutin Ivanović. (2001) PLACE AND ROLE OF NEW MEMBRANES IN MULTIPLE ORGAN FAILURE: AN ADVANCE OR RUMORS. Renal Failure 23:2, 175-181
CrossRef42
R C Albright. (2001) Acute renal failure: a practical update.. Mayo Clinic Proceedings 76:1, 67-74
CrossRef43
Hiroyuki Hirasawa, Shigeto Oda, Hidetoshi Shiga, Kenichi Matsuda. (2000) Endotoxin adsorption or hemodiafiltration in the treatment of multiple organ failure. Current Opinion in Critical Care 6:6, 421-425
CrossRef44
John T. Daugirdas. (2000) Dialysis adequacy and kinetics. Current Opinion in Nephrology and Hypertension 9:6, 599-605
CrossRef45
Jarmila Janatova. (2000) Activation and Control of Complement, Inflammation, and Infection Associated with the Use of Biomedical Polymers. ASAIO Journal 46:6, S53-S62
CrossRef46
R C Albright, J M Smelser, J T McCarthy, H A Homburger, E J Bergstralh, T S Larson. (2000) Patient survival and renal recovery in acute renal failure: randomized comparison of cellulose acetate and polysulfone membrane dialyzers.. Mayo Clinic Proceedings 75:11, 1141-1147
CrossRef47
Philip S. Barie, Lynn J. Hydo. (2000) Epidemiology of Multiple Organ Dysfunction Syndrome in Critical Surgical Illness. Surgical Infections 1:3, 173-186
CrossRef48
Enrico Fiaccadori, Umberto Maggiore, Maria Lombardi, Sabina Leonardi, Carlo Rotelli, Alberico Borghetti. (2000) Predicting patient outcome from acute renal failure comparing three general severity of illness scoring systems. Kidney International 58:1, 283-292
CrossRef49
Bertrand L. Jaber, Miguel Cendoroglo, V.S. Balakrishnan, Mary C. Perianayagam, Saliman A. Karsou, Robin Ruthazer, Andrew J. King, Brian J.G. Pereira. (2000) Impact of dialyzer membrane selection on cellular responses in acute renal failure: A crossover study. Kidney International 57:5, 2107-2116
CrossRef50
Véronique Witko-Sarsat, Philippe Rieu, Béatrice Descamps-Latscha, Philippe Lesavre, Lise Halbwachs-Mecarelli. (2000) Neutrophils: Molecules, Functions and Pathophysiological Aspects. Laboratory Investigation 80:5, 617-653
CrossRef51
Norbert Lameire, Raymond Vanholder. (2000) New perspectives for prevention/treatment of acute renal failure. Current Opinion in Anaesthesiology 13:2, 105-112
CrossRef52
W. Van Biesen, R. Vanholder, A. Van Loo, M. Van Der Vennet, N. Lameire. (2000) PERITONEAL DIALYSIS FAVORABLY INFLUENCES EARLY GRAFT FUNCTION AFTER RENAL TRANSPLANTATION COMPARED TO HEMODIALYSIS. Transplantation 69:4, 508-514
CrossRef53
Douglas E. Schaubel, Stanley S.A. Fenton. (2000) Trends in mortality rates on hemodialysis in Canada, 1981-1997. Kidney International 57:s74, 66-73
CrossRef54
Achim Jörres. (2000) Biocompatibility and acute renal failure. The Lancet 355:9200, 313-314
CrossRef55
M MEYER. (2000) RENAL REPLACEMENT THERAPIES. Critical Care Clinics 16:1, 29-58
CrossRef56
Christian Schlaeper, Richard Amerling, Markus Manns, Nathan W. Levin. (1999) High clearance continuous renal replacement therapy with a modified dialysis machine. Kidney International 56:s72, 20-23
CrossRef57
Raymond Vanholder, Norbert Lameire. (1999) Does biocompatibility of dialysis membranes affect recovery of renal function and survival?. The Lancet 354:9187, 1316-1318
CrossRef58
Achim Jörres, Gerhard M Gahl, Clemens Dobis, Momir H Polenakovic, Koco Cakalaroski, Boleslaw Rutkowski, Ewa Kisielnicka, Detlef H Krieter, K Wolfgang Rumpf, Christian Guenther, Wilhelm Gaus, Josef Hoegel. (1999) Haemodialysis-membrane biocompatibility and mortality of patients with dialysis-dependent acute renal failure: a prospective randomised multicentre trial. The Lancet 354:9187, 1337-1341
CrossRef59
Niamh E. Kieran, Hugh R. Brady. (1999) Treatment of Acute Renal Failure: Promising Experimental Strategies and New Therapeutic Challenges. Seminars in Dialysis 12:5, 275-277
CrossRef60
Andrew Briglia, Emil P. Paganini. (1999) ACUTE RENAL FAILURE IN THE INTENSIVE CARE UNIT. Clinics in Chest Medicine 20:2, 347-366
CrossRef61
Gilad E. Amiel, Anthony Atala. (1999) Current and future modalities for functional renal replacement. Urologic Clinics of North America 26:1, 235-246
CrossRef62
Robert A Star. (1998) Treatment of acute renal failure. Kidney International 54:6, 1817-1831
CrossRef63
Guido O. Perez, Gabriel Contreras. (1998) The Use of Dialysis and Hemofiltration for Complications of Liver Disease. Seminars in Dialysis 11:5, 308-316
CrossRef64
Colin H. Jones, Eddie Goutcher, Charles G. Newstead, Eric J. Will, Steven G. Dean, Alex M. Daviso. (1998) Hemodynamics and Survival of Patients with Acute Renal Failure Treated by Continuous Dialysis with Two Synthetic Membranes. Artificial Organs 22:8, 638-643
CrossRef65
Pastan, Stephen, Bailey, James, . (1998) Dialysis Therapy. New England Journal of Medicine 338:20, 1428-1437
Full Text66
Shigekazu Yuasa, Norihiro Takahashi, Tetsuo Shoji, Koichi Uchida, Hideyasu Kiyomoto, Mayuko Hashimoto, Hiroshi Fujioka, Yoko Fujita, Hirofumi Hitomi, Hirohide Matsuo. (1998) A Simple and Early Prognostic Index for Acute Renal Failure Patients Requiring Renal Replacement Therapy. Artificial Organs 22:4, 273-278
CrossRef67
Klahr, Saulo, Miller, Steven B., . (1998) Acute Oliguria. New England Journal of Medicine 338:10, 671-675
Full Text68
Alfred K. Cheung, John K. Leypoldt. (1998) Evaluation of Hemodialyzer Performance. Seminars in Dialysis 11:2, 131-137
CrossRef69
M. Bret, J. M. Hurot, A. Mercatello, B. Coronel, D. Dorez, M. Laville, J. F. Moskovtchenko. (1998) Acetate-free biofiltration for acute renal failure. Renal Failure 20:3, 493-503
CrossRef70
Colin H. Jonee. (1998) Continuous Renal Replacement Therapy in Acute Renal Failure: Membranes for CRRT. Artificial Organs 22:1, 2-7
CrossRef71
Hamid Rabb, Steven J. Agosti, Sheryl Hakala, Patricia Hoffman, W. Michael Gallatin, German Ramirez. (1998) The Leukointegrin Alpha d/Beta 2 (αd/CD18): Specific Changes in Surface Expression in Patients on Hemodialysis. Cell Communication and Adhesion 6:1, 13-20
CrossRef72
M. Papadimitriou, A. Papagianni, D. Diamantopoulou, E. Mitsopoulos, A. M. Belechri, P. Koukoudis, D. Memmos. (1998) Acute renal failure—Which treatment modality is the best?. Renal Failure 20:5, 651-661
CrossRef73
P. Nair, D. Bihari. (1997) Acute renal failure in the ICU in the 1990s — “anything goes”?. Intensive Care Medicine 23:12, 1193-1196
CrossRef74
Charles L. Edelstein, Hong Ling, Adisorn Wangsiripaisan, Robert W. Schrier. (1997) Emerging therapies for acute renal failure. American Journal of Kidney Diseases 30:5, S89-S95
CrossRef75
Rita D. Swinford, Seema Baid, Manuel Pascual. (1997) Dialysis membrane adsorption during CRRT. American Journal of Kidney Diseases 30:5, S32-S37
CrossRef76
Eric F.H. van Bommel, Huibert H. Ponssen. (1997) Intermittent versus continuous treatment for acute renal failure: Where do we stand?. American Journal of Kidney Diseases 30:5, S72-S79
CrossRef77
Glenn M. Chertow. (1997) On the design and analysis of multicenter trials in acute renal failure. American Journal of Kidney Diseases 30:5, S96-S101
CrossRef78
Johannes Hartmann, Harald Fricke, Helmut Schiffl. (1997) Biocompatible membranes preserve residual renal function in patients undergoing regular hemodialysis. American Journal of Kidney Diseases 30:3, 366-373
CrossRef79
Thomas D. DuBose, David G. Warnock, Ravindra L. Mehta, Joseph V. Bonventre, Marc R. Hammerman, Bruce A. Molitoris, Mark S. Paller, Norman J. Siegel, James Scherbenske, Gary E. Striker. (1997) Acute renal failure in the 21st century: Recommendations for management and outcomes assessment. American Journal of Kidney Diseases 29:5, 793-799
CrossRef80
James T. McCarthy, Bernice M. Jenson, David P. Squillace, Amy W. Williams. (1997) Improved preservation of residual renal function in chronic hemodialysis patients using polysulfone dialyzers. American Journal of Kidney Diseases 29:4, 576-583
CrossRef81
Allgren, Robin L., Marbury, Thomas C., Rahman, S. Noor, Weisberg, Lawrence S., Fenves, Andrew Z., Lafayette, Richard A., Sweet, Richard M., Genter, Fredric C., Kurnik, Brenda R.C., Conger, John D., Sayegh, Mohamed H., . (1997) Anaritide in Acute Tubular Necrosis. New England Journal of Medicine 336:12, 828-834
Full Text82
I. Martin, R. Quarto, B. Dozin, R. Cancedda. (1997) Producing prefabricated tissues and organs via tissue engineering. IEEE Engineering in Medicine and Biology Magazine 16:2, 73-80
CrossRef83
Manuel Pascual, MD, Rita D. Swinford, MD, Nina Tolkoff-Rubin, MD. (1997) ACUTE RENAL FAILURE: Role of Dialysis Membrane Biocompatibility. Annual Review of Medicine 48:1, 467-476
CrossRef84
Brian J. G. Pereira. (1997) Effect of the Dialysis Membrane on Mortality of Chronic Hemodialysis Patients. Hakim RM, Held PJ, Stannard DC, Wolfe RA, Port FK, Daugirdas JT, Agadoa L. Kidney International 1996, 50:566-570. Seminars in Dialysis 10:1, 61-62
CrossRef85
J. N. Hoffmann, W. H. Hartl, R. Deppisch, E. Faist, M. Jochum, D. Inthorn. (1996) Effect of hemofiltration on hemodynamics and systemic concentrations of anaphylatoxins and cytokines in human sepsis. Intensive Care Medicine 22:12, 1360-1367
CrossRef86
Glenn M Chertow, J. Michael Lazarus. (1996) Intensity of Dialysis in Established Acute Renal Failure. Seminars in Dialysis 9:6, 476-480
CrossRef87
B. Kränzlin, N. Gretz, M. Kirschfink, S.K. Mujais. (1996) Dialysis in Rats with Acute Renal Failure: Evaluation of Three Different Dialyzer Membranes. Artificial Organs 20:11, 1162-1168
CrossRef88
Wilfred Druml. (1996) Prophylactic use of continuous renal replacement therapies in patients with normal renal function. American Journal of Kidney Diseases 28:5, S114-S120
CrossRef89
Emil P. Paganini, Mihaly Tapolyai, Marleen Goormastic, William Halstenberg, Louise Kozlowski, Martine Leblanc, Jar Chi Lee, Luz Moreno, Ken Sakai. (1996) Establishing a dialysis therapy/patient outcome link in intensive care unit acute dialysis for patients with acute renal failure. American Journal of Kidney Diseases 28:5, S81-S89
CrossRef90
John D. Conger. (1996) The role of continuous renal replacement therapy in the future treatment of acute renal failure. American Journal of Kidney Diseases 28:5, S108-S113
CrossRef91
Ravindra L Mehta. (1996) Modalities of Dialysis for Acute Renal Failure. Seminars in Dialysis 9:6, 469-475
CrossRef92
Jonathan Himmelfarb, Raymond M. Hakim. (1996) The Importance of Biocompatible Membranes in Dialysis. Seminars in Dialysis 9:6, 481-483
CrossRef93
William R. Clark, Bruce A. Mueller, Michael A. Kraus, William L. Macias. (1996) Solute control by extracorporeal therapies in acute renal failure. American Journal of Kidney Diseases 28:5, S21-S27
CrossRef94
Claudio Ronco, Rinaldo Bellomo. (1996) Complications with continuous renal replacement therapy. American Journal of Kidney Diseases 28:5, S100-S104
CrossRef95
Ravindra L. Mehta. (1996) Acute renal failure in the intensive care unit: Which outcomes should we measure?. American Journal of Kidney Diseases 28:5, S74-S80
CrossRef96
Horst P. Kierdorf, Heinz G. Sieberth. (1996) Continuous renal replacement therapies versus intermittent hemodialysis in acute renal failure: What do we know?. American Journal of Kidney Diseases 28:5, S90-S96
CrossRef97
Francesco Locatelli, Francesco Mastrangelo, Bruno Redaelli, Claudio Ronco, Daniele Marcelli, Giuseppe La Greca, Giancarlo Orlandini. (1996) Effects of different membranes and dialysis technologies on patient treatment tolerance and nutritional parameters. Kidney International 50:4, 1293-1302
CrossRef98
Fernando Liaño, Julio Pascual. (1996) Epidemiology of acute renal failure: A prospective, multicenter, community-based study. Kidney International 50:3, 811-818
CrossRef99
Ahmed M. Alkhunaizi, Robert W. Schrier. (1996) Management of acute renal failure: New perspectives. American Journal of Kidney Diseases 28:3, 315-328
CrossRef100
F. Brivet, P. Loirat, D. Kleinknecht, P. Landais, . (1996) Biocompatible dialysis membrane in acute renal failure: The best choice. Intensive Care Medicine 22:8, 833-834
CrossRef101
George E. Schreiner. (1996) Hanta Is Coming. Artificial Organs 20:6, 451-455
CrossRef102
Thadhani, Ravi, Pascual, Manuel, Bonventre, Joseph V., . (1996) Acute Renal Failure. New England Journal of Medicine 334:22, 1448-1460
Full Text103
Jonathan Himmelfarb. (1996) Dialytic Therapy in Acute Renal Failure: No Reason for Nihilism. Seminars in Dialysis 9:3, 230-234
CrossRef104
JuanF. Navarro, Víctor García-Nieto, David Bihari, Imogen Mitchell, Rene Chang, Fernando Liaño, Julio Pascual, HughR. Brady, GaryG. Singer. (1996) Acute renal failure. The Lancet 347:8999, 478-479
CrossRef105
Hamid Rabb, Eduardo Calderon, Polly A. Bittle, German Ramirez. (1996) Alterations in soluble intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 in hemodialysis patients. American Journal of Kidney Diseases 27:2, 239-243
CrossRef106
Richard A Zager. (1996) Rhabdomyolysis and myohemoglobinuric acute renal failure. Kidney International 49:2, 314-326
CrossRef107
Manuel Pascual, Nina Tolkoff-Rubin, Jürg A Schifferli. (1996) Is adsorption an important characteristic of dialysis membranes?. Kidney International 49:2, 309-313
CrossRef108
G. Rialp, A. Roglan, A. J. BetbesÉ, M. PÉRez-MÁRquez, J. BallÚS, G. LÓPez-Velarde, J. A. Santos, E. Bak, A. Net. (1996) Prognostic Indexes and Mortality in Critically 111 Patients with Acute Renal Failure Treated with Different Dialytic Techniques. Renal Failure 18:4, 667-675
CrossRef109
J. C. Fink, M. A. Cooper, R. A. Zager. (1996) Hemodialysis Exacerbates Enzymuria in Patients with Acute Renal Failure: Brief Report. Renal Failure 18:6, 947-950
CrossRef110
Stanley Shaldon. (1996) Opinion. Seminars in Dialysis 9:1, 15-17
CrossRef111
V. Gašparović, M. Gjurašin, D. Ivanović, R. Radonić, M. Merkler. (1996) Biocompatible membrane in acute renal failure(ARF)-expectations&Problems. Intensive Care Medicine 22:S1, S40-40
CrossRef112
Stanley Shaldon, H. Schiffl, S.M. Lang. (1996) Biocompatible membranes in acute renal failure. The Lancet 347:8995, 205-206
CrossRef113
H.R. Brady, G.G. Singer. (1995) Acute renal failure. The Lancet 346:8989, 1533-1540
CrossRef114
Kazunori Kuroki, Sumit Roy, Frode Laerum, Tom Eirik Mollnes, Bjarte G. Solheim, Vibeke Videm. (1995) Complement Activation by Angiographic Catheters in Vitro
. Journal of Vascular and Interventional Radiology 6:5, 819-826
CrossRef115
Richard A. Ward, Kenneth R. McLeish. (1995) Hemodialysis with Cellulose Membranes Primes the Neutrophil Oxidative Burst. Artificial Organs 19:8, 801-807
CrossRef116
N.Richard Skroeder, Per Kjellstrand, Bjoern Holmquist, Carl M. Kjellstrand, Stefan H. Jacobson. (1995) On complement net generation in fast hemodialysis: Are high blood flow rates bioincompatible?. American Journal of Kidney Diseases 25:6, 896-903
CrossRef117
Hanife Kurtal, Dietrich Herrath, Klaus Schaefer. (1995) Is the Choice of Membrane Important for Patients with Acute Renal Failure Requiring Hemodialysis?. Artificial Organs 19:5, 391-394
CrossRef118
Richard A. Sherman. (1995) Briefly Noted. Seminars in Dialysis 8:3, 193-194
CrossRef119
(1995) Effect of the Dialysis Membrane in Acute Renal Failure. New England Journal of Medicine 332:14, 961-962
Full Text120
Jean-Louis Vincent, Christian Tielemans. (1995) Continuous hemofiltration in severe sepsis: Is it beneficial?. Journal of Critical Care 10:1, 27-32
CrossRef121
Turney, John H., . (1994) Acute Renal Failure -- Some Progress?. New England Journal of Medicine 331:20, 1372-1374
Full Text
- Letters
