A randomized cross-over comparison of the hemodynamic response to intermittent hemodialysis and continuous hemofiltration in ICU patients with acute renal failure.
OBJECTIVE
To compare the hemodynamic response of ICU patients with acute renal failure of a 24-h continuous arteriovenous hemofiltration (CAVH) and that of patients with a 4-h intermittent hemodialysis (HD).


METHODS
Cross-over randomized clinical trial. The two periods to be compared were a 24-h CAVH and the 24-h encompassing a 4-h HD. These two periods were separated by a 24-h wash-out period.


METHODS
Ten bed medicosurgical ICU of a tertiary care center in Paris, France.


METHODS
Inclusion criterion was the requirement of replacement therapy for acute renal failure in patients already submitted to mechanical ventilation.


METHODS
CAVH was performed with Ringers' lactate used for restitution and infused before the hemofilter. The ultrafiltrate output was maintained at around 15 ml/min. HD was performed with a bicarbonate-buffered dialysate.


METHODS
Mean arterial pressure (MAP), use of adrenergic drugs, and change in body weight during each period.


RESULTS
Twenty-seven consecutive patients were included, 15 CAVH-HD and 12HD-CAVH. CAVH and HD allowed the same metabolic efficacy. No hemodynamic parameter (MAP, amount of adrenergic drugs, change in body weight) differed between the two methods.


CONCLUSIONS
CAVH is equivalent to HD in terms of MAP and the use of vasopressive drugs and fluids. Establishing the superiority of CAVH would require carefully controlled studies assessing either outcome or changes in tissue oxygenation.
Misset
B
B
Intensive Care Unit, Hôpital Saint-Joseph, Paris, France.
Timsit
J F
JF
Chevret
S
S
Renaud
B
B
Tamion
F
F
Carlet
J
J
D058186:Acute Kidney Injury / Q000503:physiopathology* / Q000628:therapy; D018663:Adrenergic Agents / Q000627:therapeutic use; D001835:Body Weight; D018592:Cross-Over Studies; D006439:Hemodynamics; D006440:Hemofiltration; D006801:Humans; D006435:Renal Dialysis / Q000379:methods; D018709:Statistics, Nonparametric
D018663:Adrenergic Agents