Psicologia

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transition of treatment and discontinuation of renal-replacement therapy that were explicit. We agree with Maynar-Moliner et al. thatthe lack of benefit from more intensive renal-replacement therapy might be related to an excessive loss of electrolytes, micronutrients, or drugs. However, we believe that their proposed dynamicapproach is highly speculative. We agree with Uchino et al. that the rate of recovery of kidney function, which we defined as a creatinine clearance of more than 20 ml per minute, appeared to be much lowerthan rates reported in previous studies. However, when recovery of kidney function was defined as independence from dialysis, the rates of recovery were 54.8% and 75.4% among surviving patients atday 28 and day 60, respectively. Paul M. Palevsky, M.D.
VA Pittsburgh Healthcare System Pittsburgh, PA 15240 palevsky@pitt.edu

dialysis dose to continuous hemofiltration increases survival inpatients with acute renal failure. Kidney Int 2006;70:1312-7. 3. Liu KD, Himmelfarb J, Paganini E, et al. Timing of initiation of dialysis in critically ill patients with acute kidney injury. Clin J Am SocNephrol 2006;1:915-9. 4. Vinsonneau C, Camus C, Combes A, et al. Continuous venovenous haemodiafiltration versus intermittent haemodialysis for acute renal failure in patients with multiple-organdysfunction syndrome: a multicentre randomised trial. Lancet 2006;368:379-85. 5. Schortgen F, Soubrier N, Delclaux C, et al. Hemodynamic tolerance of intermittent hemodialysis in critically ill patients:usefulness of practice guidelines. Am J Respir Crit Care Med 2000;162:197-202.

Jane Hongyuan Zhang, Ph.D. Theresa Z. O’Connor, Ph.D.
VA Connecticut Healthcare System West Haven, CT 06516

forthe VA/NIH Acute Renal Failure Trial Network
1. Crowley ST, Chertow GM, Vitale J, et al. Lessons for success-

ful study enrollment from the Veterans Affairs/National Institutes of Health Acute...