A pilot randomised controlled comparison of continuous veno-venous haemofiltration and extended daily dialysis with filtration: effect on small solutes and acid-base balance.
OBJECTIVE
Continuous veno-venous haemofiltration (CVVH) is an established treatment for acute renal failure (ARF). Recently, extended intermittent dialytic techniques have been proposed for the treatment of ARF. The aim of this study was to compare these two approaches.


METHODS
Intensive care unit of tertiary hospital.


METHODS
Sixteen critically ill patients with ARF.


METHODS
Randomised controlled trial.


METHODS
We randomised sixteen patients to three consecutive days of treatment with either CVVH (8) or extended daily dialysis with filtration (EDDf) (8) and compared small-solute, electrolyte and acid-base control.


RESULTS
There was no significant difference between the two therapies for urea or creatinine levels over 3 days. Of 80 electrolyte measurements taken before treatment, 19 were abnormal. All values were corrected as a result of treatment, except for one patient in the CVVH group who developed hypophosphataemia (0.54 mmol/l) at 72 h. After 3 days of treatment, there was a mild but persistent metabolic acidosis in the EDDf group compared to the CVVH group (median bicarbonate: 20 mmol/l vs. 29 mmol/l: p=0.039; median base deficit: -4 mEq/l vs. -2.1 mEq/l, p=0.033).


CONCLUSIONS
CVVH and EDDf as prescribed achieved similar control of urea, creatinine and electrolytes. Acidosis was better controlled with CVVH.
Baldwin
Ian
I
Department of Intensive Care, Austin Health, 3084, Heidelberg, Australia. ian.baldwin@austin.org.au.|School of Nursing and Midwifery, Department of Gerontic Nursing, La Trobe University, Melbourne, Australia. ian.baldwin@austin.org.au.
Naka
Toshio
T
Department of Intensive Care, Austin Hospital, Melbourne, Australia.
Koch
Bill
B
School of Nursing and Midwifery, Department of Gerontic Nursing, La Trobe University, Melbourne, Australia.
Fealy
Nigel
N
Department of Intensive Care, Austin Hospital, Melbourne, Australia.
Bellomo
Rinaldo
R
Department of Intensive Care, Austin Hospital, Melbourne, Australia.
D018806:APACHE; D000136:Acid-Base Equilibrium; D058186:Acute Kidney Injury / Q000097:blood / Q000628:therapy*; D000368:Aged; D003422:Critical Care; D005260:Female; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D006435:Renal Dialysis / Q000379:methods*