***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT Although acute renal failure ( ARF ) is believed to be common in the setting of critical illness and is associated with a high risk of death , little is known about its epidemiology and outcome or how these vary in different regions of the world . OBJECTIVES To determine the period prevalence of ARF in intensive care unit ( ICU ) patients in multiple countries ; to characterize differences in etiology , illness severity , and clinical practice ; and to determine the impact of these differences on patient outcomes . DESIGN , SETTING , AND PATIENTS Prospect i ve observational study of ICU patients who either were treated with renal replacement therapy ( RRT ) or fulfilled at least 1 of the predefined criteria for ARF from September 2000 to December 2001 at 54 hospitals in 23 countries . MAIN OUTCOME MEASURES Occurrence of ARF , factors contributing to etiology , illness severity , treatment , need for renal support after hospital discharge , and hospital mortality . RESULTS Of 29 269 critically ill patients admitted during the study period , 1738 ( 5.7 % ; 95 % confidence interval [ CI ] , 5.5%-6.0 % ) had ARF during their ICU stay , including 1260 who were treated with RRT . The most common contributing factor to ARF was septic shock ( 47.5 % ; 95 % CI , 45.2%-49.5 % ) . Approximately 30 % of patients had preadmission renal dysfunction . Overall hospital mortality was 60.3 % ( 95 % CI , 58.0%-62.6 % ) . Dialysis dependence at hospital discharge was 13.8 % ( 95 % CI , 11.2%-16.3 % ) for survivors . Independent risk factors for hospital mortality included use of vasopressors ( odds ratio [ OR ] , 1.95 ; 95 % CI , 1.50 - 2.55 ; P<.001 ) , mechanical ventilation ( OR , 2.11 ; 95 % CI , 1.58 - 2.82 ; P<.001 ) , septic shock ( OR , 1.36 ; 95 % CI , 1.03 - 1.79 ; P = .03 ) , cardiogenic shock ( OR , 1.41 ; 95 % CI , 1.05 - 1.90 ; P = .02 ) , and hepatorenal syndrome ( OR , 1.87 ; 95 % CI , 1.07 - 3.28 ; P = .03 ) . CONCLUSION In this multinational study , the period prevalence of ARF requiring RRT in the ICU was between 5 % and 6 % and was associated with a high hospital mortality rate To find the optimal exchange volume and dialysate flow rate for use in peritoneal dialysis , 24 adult patients with acute or acute on chronic renal failure were studied . Based on the exchange volume and duration of one cycle , patients were r and omly divided into 4 equal groups . Peritoneal clearances for urea and creatinine were calculated at 2 , 8 and 14 hours during dialysis . Increase of dialysate flow rate improved the peritoneal clearance of various solutes , and for the same flow rate 2 liter exchange volume gave better results than 1 liter exchange volume Abstract . In critically ill children , acute renal failure ( ARF ) is associated with a high mortality . To assess the outcome and complications of pump-assisted hemofiltration ( PAHF ) using a st and ard volumetric pump to regulate blood flow , we retrospectively review ed our experience in 52 patients with ARF treated with PAHF from 1989 to 1995 . These patients ranged in age from < 1 month to 19 years and in weight from 2 to 125 kg . The most common underlying diagnoses were congenital heart disease and infection . The duration of PAHF averaged 9±8 days ( range 24 h to 43 days ) . Hemodiafiltration for solute control was required in 40 patients . Total fluid intake while on PAHF was 136±95 ml/kg per day , while urine output and ultrafiltration averaged 15±24 ml/kg per day and 89±58 ml/kg per day , respectively . Management of laboratory abnormalities was efficient with only 4 patients requiring 1 or 2 additional treatments of hemodialysis for control of uremia . Complications included hyponatremia in 13 patients , hypokalemia in 14 patients , hypovolemia in 8 patients , hyperglycemia in 6 patients , and bleeding in 9 patients . No complications specifically related to use of the volumetric infusion pump for PAHF were noted . PAHF using a volumetric infusion pump for blood flow regulation in critically ill children with ARF is a practical and efficient therapy ♦ Background : There are few reports on the role of peritoneal dialysis in critically ill patients requiring continuous renal replacement therapies . ♦ Methods : Patients with acute kidney injury and multi-organ involvement were r and omly allotted to continuous venovenous hemodiafiltration(CVVHDF , group A ) or to continuous peritoneal dialysis ( CPD , group B ) . Cause and severity of renal failure were assessed at the time of initiating dialysis . Primary outcome was the composite correction of uremia , acidosis , fluid overload , and hyperkalemia . Secondary outcomes were improvement of sensorium and hemodynamic instability , survival , and cost . ♦ Results : Groups A and B comprised 25 patients each with mean ages of 45.32 ± 17.53 and 48.44 ± 17.64 respectively . They received 21.68 ± 13.46 hours and 66.02 ± 69.77 hours of dialysis respectively ( p = 0.01 ) . Composite correction was achieved in 12 patients of group A ( 48 % ) and in 14 patients of group B ( 56 % ) . Urea and creatinine clearances were significantly higher in group A ( 21.72 ± 10.41 mL/min and 9.36 ± 4.93 mL/min respectively vs. 22.13 ± 9.61 mL/min and 10.5 ± 6.07 mL/min , p < 0.001 ) . Acidosis was present in 21 patients of group A ( 84 % ) and in 16 of group B ( 64 % ) ; correction was better in group B ( p < 0.001 ) . Correction of fluid overload was faster and the amount of ultrafiltrate was significantly higher in group A ( 20.31 ± 21.86 L vs. 5.31 ± 5.75 L , p < 0.001 ) . No significant differences were seen in correction of hyperkalemia , altered sensorium , or hemodynamic disturbance . Mortality was 84 % in group A and 72 % in group B. Factors that influenced outcome were the APACHE ( Acute Physiology and Chronic Health Evaluation ) II score ( p = 0.02 ) and need for ventilatory support ( p < 0.01 ) . Cost of disposables was higher in group A than in group B [ INR 7184 ± 1436 vs. INR 3009 ± 1643 , p < 0.001 ( US$ 1 = INR 47 ) ] . ♦ Conclusions : Based on this pilot study , CPD may be a cost-conscious alternative to CVVHDF ; differences in metabolic and clinical outcomes are minimal The optimal dialysis dose for the treatment of acute kidney injury ( AKI ) is controversial . No studies have directly examined the effects of peritoneal dialysis ( PD ) dose on outcomes in AKI . From January 2005 to January 2007 , we r and omly assigned critically ill patients with AKI to receive higher- or lower-intensity PD therapy ( prescribed Kt/Vof 0.8 and 0.5 per session respectively ) . The main outcome measure was death within 30 days . Of the 61 enrolled patients , 30 were r and omly assigned to higher-intensity therapy , and 31 , to a lower-intensity PD dose . The two study groups had similar baseline characteristics and received treatment for 6.1 days and 5.7 days respectively ( p = 0.42 ) . At 30 days after r and omization , 17 deaths had occurred in the higher-intensity group ( 55 % ) , and 16 deaths , in the lower-intensity group ( 53 % , p = 0.83 ) . There was a significant difference between the groups in the PD dose prescribed compared with the dose delivered ( higher-intensity group : 0.8 vs. 0.59 , p = 0.04 ; lower-intensity group : 0.5 vs. 0.49 , p = 0.89 ) . The groups had similar metabolic control after 4 PD sessions ( blood urea nitrogen : 69.3 + /- 14.4 mg/dL and 60.3 + /- 11.1 mg/dL respectively , p = 0 . 71 ) . In critically ill patients with AKI , an intensive PD dose did not lower the mortality or improve the recovery of kidney function or metabolic control . The PD dose is limited by dialysate flow and membrane permeability , and clearance per exchange can decrease if a shorter dwell time is applied There is no consensus in the literature on the best renal replacement therapy ( RRT ) in acute kidney injury ( AKI ) , with both hemodialysis ( HD ) and peritoneal dialysis ( PD ) being used as AKI therapy . However , there are concerns about the inadequacy of PD as well as about the intermittency of HD complicated by hemodynamic instability . Recently , continuous replacement renal therapy ( CRRT ) have become the most commonly used dialysis method for AKI around the world . A prospect i ve r and omized controlled trial was performed to compare the effect of high volume peritoneal dialysis ( HVPD ) with daily hemodialysis ( DHD ) on AKI patient survival . A total of 120 patients with acute tubular necrosis ( ATN ) were assigned to HVPD or DHD in a tertiary-care university hospital . The primary end points were hospital survival rate and renal function recovery , with metabolic control as the secondary end point . Sixty patients were treated with HVPD and 60 with DHD . The HVPD and DHD  groups were similar for age ( 64.2+/-19.8 and 62.5+/-21.2 years ) , gender ( male : 72 and 66 % ) , sepsis ( 42 and 47 % ) , hemodynamic instability ( 61 and 63 % ) , severity of AKI ( Acute Tubular Necrosis-Index Specific Score ( ATN-ISS ) : 0.68+/-0.2 and 0.66+/-0.2 ) , Acute Physiology , Age , and Chronic Health Evaluation Score ( APACHE II ) ( 26.9+/-8.9 and 24.1+/-8.2 ) ,  pre-dialysis BUN ( 116.4+/-33.6 and 112.6+/-36.8 mg per 100 ml ) , and creatinine ( 5.8+/-1.9 and 5.9+/-1.4 mg per 100 ml ) . Weekly delivered Kt/V was 3.6+/-0.6 in HVPD and 4.7+/-0.6 in DHD ( P<0.01 ) . Metabolic control , mortality rate ( 58 and 53 % ) , and renal function recovery ( 28 and 26 % ) were similar in both groups , whereas HVPD was associated with a significantly shorter time to the recovery of renal function . In conclusion , HVPD and DHD can be considered as alternative forms of RRT in AKI Background Acute kidney injury ( AKI ) requiring dialysis in critically ill patients is associated with an in-hospital mortality rate of 50–80 % . Extended daily hemodialysis ( EHD ) and high volume peritoneal dialysis ( HVPD ) have emerged as alternative modalities . Methods A double-center , r and omized , controlled trial was conducted comparing EHD versus HVPD for the treatment for AKI in the intensive care unit ( ICU ) . Four hundred and seven patients were r and omized and 143 patients were analyzed . Principal outcome measure was hospital mortality , and secondary end points were recovery of renal function and metabolic and fluid control . Results There was no difference between the two groups in relation to median ICU stay [ 11 ( 5.7–20 ) vs. 9 ( 5.7–19 ) ] , recovery of kidney function ( 26.9 vs. 29.6 % , p = 0.11 ) , need for chronic dialysis ( 9.7 vs. 6.5 % , p = 0.23 ) , and hospital mortality ( 63.4 vs. 63.9 % , p = 0.94 ) . The groups were different in metabolic and fluid control . Blood urea nitrogen ( BUN ) , creatinine , and bicarbonate levels were stabilized faster in EHD group than in HVPD group . Delivered Kt/V and ultrafiltration were higher in EHD group . Despite r and omization , there were significant differences between the groups in some covariates , including age , pre-dialysis BUN , and creatinine levels , 
    Output:
    
Based on moderate ( mortality , recovery of kidney function ) , low ( infectious complications ) , or very low certainty evidence ( correction of acidosis ) there is probably little or no difference between PD and extracorporeal therapy for treating AKI .
Fluid removal ( low certainty ) and weekly delivered Kt/V ( very low certainty ) may be higher with extracorporeal therapy