title: Efficacy and cardiovascular tolerability of extended dialysis in critically ill patients: a randomized controlled study.
abstract: BACKGROUND
  Extended dialysis is an increasingly used modality of renal replacement therapy that theoretically offers advantages of both intermittent and continuous therapies in the intensive care unit (ICU).
  
  
  METHODS
  We randomly treated 39 ventilated critically ill patients with oliguric acute renal failure with either continuous venovenous hemofiltration (CVVH; n = 19; age, 50.1 +/- 3.2 years; Acute Physiology and Chronic Health Assessment II [APACHE II] score, 32.3 +/- 1.2; 79% sepsis) and a substitution fluid rate of at least 30 mL/kg/h for 24 hours or with extended dialysis for 12 hours (n = 20; age, 50.8 +/- 3.6 years; APACHE II score, 33.6 +/- 1.0; 85% sepsis). The latter was performed using an easy-to-handle, single-pass, batch dialysis system. All hemodynamic parameters were monitored invasively by means of an indwelling arterial catheter.
  
  
  RESULTS
  Average mean arterial blood pressure, heart rate, cardiac output, systemic vascular resistance, and catecholamine dose were not significantly different in both therapies. Urea reduction rate was similar with extended dialysis compared with CVVH therapy (53% +/- 2% versus 52% +/- 3%; P = not significant) despite an average rate of substitution fluid with the latter of 3.2 +/- 0.1 L/h. This was corroborated by the finding of similar amounts of urea eliminated in the collected spent total hemofiltration and dialysis fluid. Correction of acidosis was accomplished faster with extended dialysis than CVVH, and the amount of heparin used was significantly lower with extended dialysis (P < 0.01).
  
  
  CONCLUSIONS
  Extended dialysis combines excellent detoxification with cardiovascular tolerability, even in severely ill patients in the ICU. The technically simple dialysis system used offers flexibility of treatment time.
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Medical School Hannover, Hannover, Germany.
authors.forename: Jan T
authors.initials: JT
authors.lastname: Kielstein
authors.forename: Ulrich
authors.initials: U
authors.lastname: Kretschmer
authors.forename: Thomas
authors.initials: T
authors.lastname: Ernst
authors.forename: Carsten
authors.initials: C
authors.lastname: Hafer
authors.forename: Matthias J
authors.initials: MJ
authors.lastname: Bahr
authors.forename: Hermann
authors.initials: H
authors.lastname: Haller
authors.forename: Danilo
authors.initials: D
authors.lastname: Fliser
mesh_terms: D018806:APACHE; D058186:Acute Kidney Injury / Q000503:physiopathology / Q000628:therapy*; D016638:Critical Illness; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000295:instrumentation / Q000379:methods*; D012121:Respiration, Artificial