Continuous renal replacement therapy: does technique influence azotemic control?
OBJECTIVE
Different techniques of continuous renal replacement therapy (CRRT) might have different effects on azotemic control. Accordingly, we tested whether continuous veno-venous hemodiafiltration (CVVHDF) or continuous veno-venous hemofiltration (CVVH) would achieve better control of serum creatinine and plasma urea levels.


METHODS
Retrospective controlled study.


METHODS
Two tertiary Intensive Care Units.


METHODS
Critically ill patients with acute renal failure (ARF) treated with CVVHDF (n = 49) or CVVH (n = 50).


METHODS
Retrieval of daily morning urea and creatinine values before and after the initiation of CRRT for up to 2 weeks of treatment.


RESULTS
Before treatment, serum urea and creatinine concentrations were significantly lower in the CVVH group than in CVVHDF group (urea: 31.0 +/- 15.0 mmol/L for CVVHDF and 24.7 +/- 16.1 mmol/L for CVVH, p = 0.01, creatinine: 547 +/- 308 micromol/L vs. 326 +/- 250 micromol/L, p < 0.0001). These differences were still significant after 48 h of treatment (urea: 20.1 +/- 8.3 mmol/L vs. 14.1 +/- 6.1 mmol/L; p = 0.0003, creatinine: 360 +/- 189pmol/L vs. 215 +/- 118 micromol/L; p < 0.0001). Throughout the duration of therapy, mean urea levels (22.3 +/- 9.0 mmol/L for CVVHDF vs. 16.7 +/- 7.8 mmol/L for CVVH, p < 0.0001) and mean creatinine levels (302 +/- 167 vs. 211 +/- 103 micromol/L, p < 0.0001) were better controlled in the CVVH group.


CONCLUSIONS
CRRT strategies based on different techniques might have a significantly different impact on azotemic control.
Morimatsu
Hiroshi
H
Department of Intensive Care, Austin and Repatriation Medical Centre, Melbourne, Victoria.
Uchino
Shigehiko
S
Bellomo
Rinaldo
R
Ronco
Claudio
C
D058186:Acute Kidney Injury / Q000097:blood* / Q000150:complications / Q000628:therapy*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood*; D005260:Female; D017583:Hemodiafiltration; D006440:Hemofiltration; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014508:Urea / Q000097:blood*; D014511:Uremia / Q000097:blood* / Q000209:etiology / Q000517:prevention & control*
D014508:Urea; D003404:Creatinine