Continuous venovenous hemodiafiltration versus hemodialysis as renal replacement therapy in patients with acute renal failure in the intensive care unit.
OBJECTIVE
Hemodialysis (HD) and continuous venovenous hemodiafiltration (CVVHDF) have been adopted as forms of renal replacement therapy (RRT) in patients with acute renal failure (ARF). Although CVVHDF has many advantages, previous studies reported no definite improvement in survival rate compared to HD.


METHODS
In this retrospective study, 148 intensive care unit patients underwent HD (70 males, 25 females; mean age 45 +/- 17 years) or CVVHDF (42 males, 11 females; mean age 52 +/- 18 years). The severity of illness was estimated at the initiation of RRT and on the third day of RRT and presented using the APACHE III scoring system. The number of organ failures was checked at the initiation of RRT.


RESULTS
The survival rate was 46% in the HD group and 21% in the CVVHDF group (p = 0.002). CVVHDF was applied to the more severely ill patients, who had longer periods using a ventilator (p = 0.002) and/or vasopressor (p < 0.001), higher numbers of organ failures (p < 0.001) and higher initial APACHE III scores (p < 0.001). Among patients with APACHE III scores > 103, the survival rate was 13% in the CVVHDF group and 0% in the HD group. In patients with kidney failure and failure of two other organs, the survival rate was 9% in the HD group and 36% in the CVVHDF group (p = 0.035).


CONCLUSIONS
The mortality rate in the CVVHDF group was higher than that in the HD group, which may have been because CVVHDF was applied to the more severely ill patients. In contrast, CVVHDF may give a chance of survival to patients with APACHE III scores > 103 and may be more useful than HD in patients with failure of three or more organs.
Chang
Jai Won
JW
Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea.
Yang
Won Seok
WS
Seo
Jang Won
JW
Lee
Joon Seung
JS
Lee
Sang Koo
SK
Park
Su-Kil
SK
D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D017583:Hemodiafiltration / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D007677:Kidney Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D006435:Renal Dialysis / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome