title: High-risk surgical acute renal failure treated by continuous arteriovenous hemodiafiltration: metabolic control and outcome in sixty patients.
abstract: The outcome and metabolic control was studied in 60 critically ill patients with acute renal failure (ARF) treated by continuous arteriovenous hemodiafiltration (CAVHD) in a single surgical intensive care unit. Mean age (+/- SEM) was 60 +/- 2 years with a male predominance (80%). The majority of patients required mechanical ventilation (83%) and/or vasopressor support (70%) and suffered from multiorgan failure [mean number of organ system failures 3.3 +/- 0.3 (range 1-6)]. CAVHD resulted in a rapid decline of serum urea and creatinine levels during the first 72 h (urea 47.4 +/- 2.3 to 30.3 +/- 1.4 mmol/l, p < 0.05, and creatinine 572 +/- 27 to 361 +/- 23 mumol/l, p < 0.05); thereafter, controlled steady-state levels were achieved with serum urea levels kept below 30 mmol/l with full protein alimentation and often despite hypotension, surgery and septicemia. Significant electrolyte derangements could be easily corrected and maintained within normal limits. Bicarbonate homeostasis could be restored within 48 h in patients with severe metabolic acidosis (HCO3- < 20 mmol/l) with use of bicarbonate as a buffering anion (17 +/- 0.5 to 23.2 +/- 0.6, p < 0.05). CAVHD allowed rapid removal of excess body and lung water (up to 5 liters/day) without hemodynamic instability. Despite a mean pretreatment APACHE II score of 26.5, 26 patients (43%) survived until discharge from the intensive care unit, of whom 23 (38%) survived to leave hospital. Requirement of mechanical ventilation or vasopressor support, higher APACHE II scores and septicemia were all associated with a poor prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Internal Medicine I, University Hospital Rotterdam Dijkzigt, The Netherlands.
authors.forename: E F
authors.initials: EF
authors.lastname: van Bommel
authors.forename: N D
authors.initials: ND
authors.lastname: Bouvy
authors.forename: K L
authors.initials: KL
authors.lastname: So
authors.forename: H H
authors.initials: HH
authors.lastname: Vincent
authors.forename: R
authors.initials: R
authors.lastname: Zietse
authors.forename: H A
authors.initials: HA
authors.lastname: Bruining
authors.forename: W
authors.initials: W
authors.lastname: Weimar
mesh_terms: D018806:APACHE; D000138:Acidosis / Q000097:blood; D058186:Acute Kidney Injury / Q000097:blood / Q000601:surgery / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003404:Creatinine / Q000097:blood; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D005260:Female; D017583:Hemodiafiltration / Q000009:adverse effects; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010710:Phosphates / Q000097:blood; D011188:Potassium / Q000097:blood; D012964:Sodium / Q000097:blood; D017693:Sodium Bicarbonate / Q000008:administration & dosage; D013997:Time Factors; D016896:Treatment Outcome; D014508:Urea / Q000097:blood
chemical_list: D010710:Phosphates; D017693:Sodium Bicarbonate; D014508:Urea; D012964:Sodium; D003404:Creatinine; D011188:Potassium