Effect of filtration volume of continuous venovenous hemofiltration in the treatment of patients with acute renal failure in intensive care units.
OBJECTIVE
We evaluated the variable Kt/V, which has become established in the therapy of end-stage renal disease in acute renal failure, to assess the influence of the filtration volume of continuous venovenous hemofiltration on Kt/V. We measured the variables of acid-base balance and uremia control.


METHODS
Prospective interventional pilot study.


METHODS
Medical intensive care unit of a university hospital.


METHODS
Fifty-six patients with acute renal failure and continuous venovenous hemofiltration treatment.


METHODS
The patients were consecutively treated with a filtration volume of either 1 L/hr (group 1) or 1.5 L/hr (group 2).


RESULTS
Patients with a filtration volume of 1.5 L/hr achieved a Kt/V of 0.8 per day, which was significantly higher than in the patient group treated with 1 L/hr (0.53, p <.05). The filtration volume of 1.5 L/hr led to a markedly better control of blood urea nitrogen concentrations, 69.3 +/- 6.6 mg/dL vs. 52.1 +/- 5.2 (p <.05), and to a much quicker and longer lasting compensation of acidosis. Both groups had acidotic pH at the beginning of therapy (group 1, 7.29 +/- 0.02; group 2, 7.29 +/- 0.02, nonsignificant). In group 2, a significantly higher pH value than in group 1 was measured after 24 hrs of continuous venovenous hemofiltration (p < .001; 7.39 +/- 0.02 vs. 7.31 +/- 0.02). The pH values in group 1 did not normalize until after 4 days. The filtration volume of 1.5 L/hr led to a quicker increase in bicarbonate concentrations after 24 hrs of therapy (group 1, 2.8 +/- 3.2 mmol/L; group 2, 6.5 +/- 3.1 mmol/L, p <.001).


CONCLUSIONS
The standardized urea clearance Kt/V is a valuable tool in the treatment of acute renal failure. Higher Kt/V levels were associated with a better control of uremia and acid-base balance. However, there were no differences in the clinical course, patient survival, percentage of patients with or without renal failure who were transferred from the intensive care unit, or Acute Physiology and Chronic Health Evaluation III scores.
Brause
Matthias
M
Department of Nephrology and Rheumatology, University Clinic, Düsseldorf, Germany. dr.brause@dialyse-duesseldorf.de
Neumann
A
A
Schumacher
T
T
Grabensee
B
B
Heering
Peter
P
D018806:APACHE; D000138:Acidosis / Q000209:etiology; D058186:Acute Kidney Injury / Q000150:complications / Q000378:metabolism* / Q000401:mortality / Q000628:therapy*; D000368:Aged; D001639:Bicarbonates / Q000097:blood; D001806:Blood Urea Nitrogen; D001810:Blood Volume; D001835:Body Weight; D002245:Carbon Dioxide / Q000097:blood; D003404:Creatinine / Q000097:blood; D003422:Critical Care / Q000379:methods; D016638:Critical Illness; D005260:Female; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007773:Lactates / Q000097:blood; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D010865:Pilot Projects; D011379:Prognosis; D011446:Prospective Studies; D018805:Sepsis / Q000150:complications; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D001639:Bicarbonates; D007773:Lactates; D002245:Carbon Dioxide; D003404:Creatinine