Continuous arteriovenous and intermittent hemofiltration in renal failure.
The clinical applications of continuous arteriovenous and intermittent hemofiltration (CAVH and IHF) have changed the concept of renal failure treatment which was previously understood to be hemodialysis (HD). To perform such treatments a reliable vascular access is a vital priority. Unfortunately, multiple vascular access problems are frequently seen among chronic HD or HF patients despite the reliability of the conventional arteriovenous fistula. In this study a needleless prosthetic vascular access device (Hemasite) has been tried (32 devices in 28 HD/HF patients) as an alternative solution. The five-year follow-up showed that the Hemasite device offered an immediate and reliable vascular access with adequate blood flow. The one-year cumulative survival rate was 55%. Thrombosis and infection were the two main causes for the implant loss. On the other hand, evaluation of our experience with acute vascular access in acute renal failure (ARF) in 76 patients showed that the most commonly used one was the Buselmeier shunt (75%), followed by the femoral catheters (23%) for femoral vessels catheterization, and the Scribner shunt (2%). The Buselmeier shunt gave adequate blood flow. It was safe and easy to manipulate in case of trouble during treatment (e.g. clotting). The outcome of CAVH as a first choice treatment modality for ARF in our centre, since 1982, was evaluated in 40 critically ill intensive care patients during the period July 1987-December 1988. The total survival improved from 45% (in a previous and similar study) to 55%. However, CAVH was found of limited role in uremic control in severe hypercatabolic states. In order to find an alternative solution, CAVH and continuous hemodialysis (CAVHD) were compared in 13 ARF patients. Better results in uremic control were achieved with CAVHD. The net ultrafiltration (UF) volume was lower in CAVHD. Furthermore both UF and diffusion could be combined during CAVHD treatment to give freedom for nutritional support as well as fluid removal. Renal failure patients are prone to infections because they are often critically ill, in case of ARF, or because of their disturbed immune system in case of chronic renal failure. Such patients are in need of urgent and adequate antibiotic treatment. Both renal failure and IHF create difficulties in antibiotics dosing. The pharmacokinetics of a potent broad spectrum antibiotic (imipenem/cilastatin) was studied during IHF for the purpose of dose adjustment. 75% of the given dose was eliminated by HF. Dosage recommendations were given. Fluid overload is a common finding in renal failure.(ABSTRACT TRUNCATED AT 400 WORDS)
Alarabi
A A
AA
Department of Internal Medicine, University Hospital, Uppsala, Sweden.
D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D005260:Female; D006440:Hemofiltration / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged