Hemodynamics and survival of patients with acute renal failure treated by continuous dialysis with two synthetic membranes.
Synthetic membranes are not identical and have specific interactions that may be harmful or beneficial. We have investigated the incidence of hypotension and the outcome of acute renal failure (ARF) in ventilated patients treated by continuous venovenous dialysis with 2 different synthetic membranes. In Study 1, the mean arterial pressure (MAP) and systemic vascular resistance (SVR) were monitored during the first 12 min of dialysis with polyacrylonitrile (PAN). In Study 2, the MAP and survival rates were compared in patients randomly assigned to either PAN or polysulfone. No subjects were receiving angiotensin converting enzyme inhibitors. In Study 1, the MAP decreased due to a reduction in the SVR during the first 6 min of dialysis but returned to the baseline value by 12 min in 22 patients during 27 dialysis treatments. In Study 2, the MAP was lower than the baseline value at 6 min during 233 dialysis treatments in 133 patients randomly assigned to PAN or polysulfone membranes (PAN group, 81.5 +/- 15 to 78.7 +/- 15.6 mm Hg, p = 0.001; and polysulfone group, 81.3 +/- 15.4 to 80.0 +/- 15.7 mm Hg, p = 0.06). Severe reductions in the MAP were seen during 13.2% of the PAN and 7.2% of the polysulfone treatments (chi 2, p = NS). The age, APACHE II score, MAP, inotrope requirement, and primary diagnosis did not differ according to membrane material in a total of 197 consecutive patients (PAN, n = 97; polysulfone, n = 100). Patients survival was 29% (PAN) and 27% (polysulfone). In multivariate analysis, APACHE II score, inotrope requirement, and liver failure were significant determinants of survival. In conclusion, PAN and polysulfone membranes were not different with respect to hypotensive reactions or survival in critically ill patients undergoing continuous venovenous hemodialysis.
Department of Renal Medicine, St. James's University Hospital, Leeds, West Yorkshire, U.K.
C H
CH
Jones
E
E
Goutcher
C G
CG
Newstead
E J
EJ
Will
S G
SG
Dean
A M
AM
Davison
D018806:APACHE; D000180:Acrylic Resins; D058186:Acute Kidney Injury / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D001672:Biocompatible Materials; D001794:Blood Pressure; D006439:Hemodynamics; D006440:Hemofiltration / Q000295:instrumentation; D006801:Humans; D008567:Membranes, Artificial; D008875:Middle Aged; D011108:Polymers; D011446:Prospective Studies; D013450:Sulfones; D015996:Survival Rate; D014655:Vascular Resistance
D000180:Acrylic Resins; D001672:Biocompatible Materials; D008567:Membranes, Artificial; D011108:Polymers; D013450:Sulfones; C010504:polyacrylonitrile; C017662:polysulfone P 1700