Hemofiltration and peritoneal dialysis in infection-associated acute renal failure in Vietnam.
BACKGROUND
In some parts of the world, peritoneal dialysis is widely used for renal replacement in acute renal failure. In resource-rich countries, it has been supplanted in recent years by hemodialysis and, most recently, by hemofiltration and associated techniques. The relative efficacy of peritoneal dialysis and hemofiltration is not known.


METHODS
We conducted an open, randomized comparison of pumped venovenous hemofiltration and peritoneal dialysis in patients with infection-associated acute renal failure in an infectious-disease referral hospital in Vietnam.


RESULTS
Seventy adult patients with severe falciparum malaria (48 patients) or sepsis (22 patients) were enrolled; 34 were assigned to hemofiltration and 36 to peritoneal dialysis. The mortality rate was 47 percent (17 patients) in the group assigned to peritoneal dialysis, as compared with 15 percent (5 patients) in the group assigned to hemofiltration (P=0.005). The rates of resolution of acidosis and of decline in the serum creatinine concentration in the group assigned to hemofiltration were more than twice those in the group assigned to peritoneal dialysis (P<0.005), and renal-replacement therapy was required for a significantly shorter period. In a multivariate analysis, the odds ratio for death was 5.1 (95 percent confidence interval, 1.6 to 16) and that for a need for future dialysis was 4.7 (95 percent confidence interval, 1.3 to 17) in the group assigned to peritoneal dialysis. The cost of hemofiltration per survivor was less than half that of peritoneal dialysis, and the cost per life saved was less than one third.


CONCLUSIONS
Hemofiltration is superior to peritoneal dialysis in the treatment of infection-associated acute renal failure.
Phu
Nguyen Hoan
NH
Center for Tropical Diseases, Center for Tropical Diseases, Cho Quan Hospital, Ho Chi Minh City, Vietnam.
Hien
Tran Tinh
TT
Mai
Nguyen Thi Hoang
NT
Chau
Tran Thi Hong
TT
Chuong
Ly Van
LV
Loc
Pham Phu
PP
Winearls
Christopher
C
Farrar
Jeremy
J
White
Nicholas
N
Day
Nicholas
N
D000138:Acidosis / Q000209:etiology / Q000628:therapy; D058186:Acute Kidney Injury / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000150:complications; D003362:Cost-Benefit Analysis; D003401:Creatine / Q000097:blood; D005260:Female; D006440:Hemofiltration / Q000009:adverse effects / Q000191:economics; D006801:Humans; D016778:Malaria, Falciparum / Q000150:complications; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D018805:Sepsis / Q000150:complications
D003401:Creatine