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February 1983

Persistent High Mortality in Acute Renal Failure: Are We Asking the Right Questions?

Author Affiliations

Division of Medicine Walter Reed Army Institute of Research Washington, DC 20012

Arch Intern Med. 1983;143(2):209-212. doi:10.1001/archinte.1983.00350020027004

Since the introduction of the artificial kidney by Kolff in the 1940s, increasing numbers of patients with acute renal failure of diverse causes have been treated with this modality. Since Kolff's original model, important advances have occurred in the design of dialysis equipment and supplies to facilitate the ease of dialysis therapy and reduce the complications related to the technical aspects of dialysis. Earlier institution and increased frequency of dialysis have attempted to lessen the accumulation of nitrogenous wastes and other toxic metabolites and have attempted to prevent fluid accumulation and electrolyte disturbances with the intention of reducing the complications of uremia. Greater attention to the metabolic needs of the patient in terms of various forms of enteric or parenteral nutrition have been recommended in an attempt to prevent catabolic wasting, enhance the use of endogenous urea, and hasten the recovery of renal function.

Despite these advances, a notable body