title: Early implementation of continuous venovenous haemodiafiltration improves outcome in patients with heart failure complicated by acute kidney injury.
abstract: BACKGROUND
  Acute kidney injury (AKI) is a serious complication of heart failure (HF). Continuous venovenous haemodiafiltration (CVVHDF) is a widely accepted method for treating this complication. However, the optimal time of its initiation has not been established.
  
  
  OBJECTIVE
  To compare the outcome of patients with HF treated with CVVHDF which was implemented late (the first two years of our experience) or early (the next two years of our experience).
  
  
  METHODS
  Thirty seven patients, mean age 65 years, were hospitalised between April 2006 and January 2010 with the diagnosis of HF complicated by AKI. The primary cardiovascular diseases were: valvular heart disease (30%), acute coronary syndrome (27%), dilated cardiomyopathy (16%), exacerbation of chronic HF (11%), and others (16%). The inclusion criteria for CVVHDF therapy were: symptoms of HF including cardiogenic shock with high levels of creatinine (≥ 300 μmol/L) and/or oliguria and/or symptoms of septic shock. The exclusion criteria were: serious coagulation disturbances or inability of placing a catheter in a central vein. Group A consisted of 12 patients treated from April 2006 to the end of 2007. In group B, there were 25 patients treated from the beginning of 2008 to January 2010. Before treatment, mean ejection fraction, left ventricular diastolic diameter and mean blood pressure in both groups were comparable. Renal replacement therapy in group B was started earlier than in group A (mean 2.0 ± 2.0 days vs 4.0 ± 4.3 days from the onset of symptoms of AKI; NS).
  
  
  RESULTS
  The day after the beginning of CVVHDF, renal failure parameters improved in both groups, but the improvement was much more significant in group B. In group A, 11 (92%) patients died. The mean CVVHDF duration was six days and all patients required mechanical ventilation. In group B, 17 (68%) patients died (NS). The mean CVVHDF duration was shortened to four days. Seventeen (68%) patients were ventilated mechanically and this parameter was significantly different between the groups (p = 0.03)
  
  
  CONCLUSIONS
  An early introduction of CVVHDF significantly diminished the need to use mechanical ventilation and indicated a positive trend in the reduction of in-hospital mortality in patients with HF complicated by AKI.
authors.affiliation: Intensive Cardiac Therapy Clinic, Institute of Cardiology, Warsaw, Poland. akonopka@ptkardio.pl
authors.forename: Anna
authors.initials: A
authors.lastname: Konopka
authors.forename: Marek
authors.initials: M
authors.lastname: Banaszewski
authors.forename: Izabela
authors.initials: I
authors.lastname: Wojtkowska
authors.forename: Janina
authors.initials: J
authors.lastname: Stępińska
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications* / Q000401:mortality / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000401:mortality / Q000628:therapy; D017583:Hemodiafiltration / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000379:methods*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome