• The primary objective is to determine whether CVVHDF using an ultrafiltration rate of 35 ml/hr/kg (high dose) leads to a greater reduction in all-cause mortality compared to standard CVVHDF using an ultrafiltration rate of 20 ml/hr/kg. [ Time Frame: The prescribed ultafiltration dose will be delivered for the duration of CRRT or until either ICU discharge or 30 days whichever occurs first ]
  

Although the worldwide standard for renal replacement therapy is intermittent hemodialysis(IHD), continuous renal replacement therapy (CRRT) has emerged as an alternative form of renal replacement therapy in the critical care setting due to its advaantages of slow continuous fluid remaoval, steady acid-base correction, and hemodynamic stability.

There are no standard protocols for initiating or administering CRRT, and practice patterns vary widely among institutions, with less than 25% of patients with ARF in the ICU receiving this therapy in the United States.

Various CRRT modalities are available that use diffusion, convection, or a combination of both to obtain adequate solute clearance. However, there is no consensus as to the optimal dialysis modality, adequate dialysis dose, or optimal clearance modality (convection vs. diffusion). Clinical trials are needed to determine the optimal method of adminstering CRRT, with respect to modality, dose of dialysis, and time of initiation of therapy.

Although some studies suggest that a higher dose of dialysis improves survival, there have been no prospective randomized studies comparing the effectiveness of diffusion and convection, combined together, for solute clearance.