Continuous arteriovenous hemodialysis: an alternative therapy for acute renal failure associated with critical illness.
Critically ill patients often cannot tolerate conventional hemodialysis because of hemodynamic instability. Continuous arteriovenous hemofiltration provides control of fluid and electrolyte balance but is inefficient in the management of azotemia. Continuous arteriovenous hemodialysis (CAVHD) combines dialysis with hemofiltration. We performed 15 CAVHD treatments of 2 or more days' duration in 12 critically ill patients aged 23 to 85 (mean 64.4) years who had acute oliguric renal failure as a component of multiple organ system failure and who were unsuitable for conventional hemodialysis. The total treatment time was 106 days. The serum creatinine and urea levels were controlled in all the patients during CAVHD. The ultrafiltrate losses were sufficient to allow appropriate nutrition and fluid administration and still maintain a negative fluid balance. Renal function returned in five patients (42%), of whom four survived to be discharged home. CAVHD is an effective means of managing acute oliguric renal failure in critically ill patients.
Gibney
R T
RT
Department of Medicine, General Hospital (Grey Nuns) of Edmonton.
Stollery
D E
DE
Lefebvre
R E
RE
Sharun
C J
CJ
Chan
P
P
D058186:Acute Kidney Injury / Q000097:blood / Q000150:complications* / Q000401:mortality; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003404:Creatinine / Q000097:blood; D003422:Critical Care; D005069:Evaluation Studies as Topic; D005260:Female; D006440:Hemofiltration / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007688:Kidneys, Artificial; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000150:complications* / Q000401:mortality; D011379:Prognosis; D013997:Time Factors; D014508:Urea / Q000097:blood
D014508:Urea; D003404:Creatinine