Epidemiology and prognostic factors of critically ill patients treated with hemodiafiltration.
OBJECTIVE
The objective of this study is to study the epidemiology, outcome, and prognostic factors of critically ill patients treated with continuous venovenous hemodiafiltration (CVVHDF).


METHODS
Observational cohort was done in a French 16-bed intensive care unit (ICU) from a university-affiliated urban hospital. All patients requiring, in the opinion of the treating physician, the initiation of CVVHDF were included in the study.


RESULTS
One hundred ninety-seven patients with acute renal failure (ARF) treated with CVVHDF were studied. The incidence of ARF treated with CVVHDF was 5.9% in the ICU with a mortality rate of 71.6%. A multivariate analysis identified 3 independent factors associated with fatal outcome: mechanical ventilation, sepsis, and septic shock requiring vasoactive drug. In contrast, 2 independent factors predicted a favorable outcome: nonoliguric ARF and serum creatinine concentration higher than 34 mg/L at CVVHDF initiation. A flowchart determined by the chi2 Automatic Interaction and Detection statistical method allowed for the identification of patients' subgroups with different mortality rates ranging from 25% to 100%.


CONCLUSIONS
In our series, ARF treated with CVVHDF was associated with a high overall ICU mortality rate (71.6%). However, our prognostic flowchart identified patients with low mortality rates for which renal replacement therapy must be initiated with no discussion as soon as required.
Soubrier
Stéphane
S
Service de Réanimation Médicale, Hôpital Calmette, CHRU, 59037 Lille Cedex, France. ssoubrier@nordnet.fr
Leroy
Olivier
O
Devos
Patrick
P
Nseir
Saad
S
Georges
Hugues
H
d'Escrivan
Thibaud
T
Guery
Benoit
B
D058186:Acute Kidney Injury / Q000401:mortality / Q000628:therapy*; D000368:Aged; D016009:Chi-Square Distribution; D016638:Critical Illness; D005260:Female; D005602:France / Q000453:epidemiology; D017583:Hemodiafiltration; D006801:Humans; D015994:Incidence; D008297:Male; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012189:Retrospective Studies