Implementing on-line hemodiafiltration as a renal replacement therapy for ICU acute renal failure: a single-center report of feasibility, safety and hemodynamic tolerance over a seven-year period.
OBJECTIVE
On-line hemodiafiltration (HDF) is not yet routinely used in ICUs given the potential risk of microbial contamination of dialysis fluids. We evaluated the safety and the tolerance of its use in our ICU.


METHODS
A weekly measurement of bacterial growth (CFU/ml) and endotoxin level (endotoxin units/ml) was performed in dialysis fluids over a 7-year period. Intradialytic hypotensive events and pyrogenic reactions were collected during 466 on-line HDF sessions.


RESULTS
A bacterial count <0.1 CFU/ml was achieved in 977/978, 288/290, and 278/280, and an endotoxin level <0.03 endotoxin units/ml in 564/576, 330/337 and 318/323 ultrapure water, dialysate, and infusate samples, respectively. Seventy-six intradialytic hypotensive events but no pyrogenic reaction occurred.


CONCLUSIONS
The great majority of dialysis fluid samples were considered suitable with a 99% compliance rate. Use of on-line HDF, at a large scale of dialysate and infusate flows, is well tolerated and may be safely performed in critically ill.
Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France. k-klouche@chu-montpellier.fr
Kada
K
Klouche
Laurent
L
Amigues
Marianne
M
Serveaux-Delous
Sonia
S
Machado
Jean-Philippe
JP
Delabre
Erick
E
Laydet
Philippe
P
Mauran
Olivier
O
Jonquet
Bernard
B
Canaud
D058186:Acute Kidney Injury / Q000628:therapy*; D000368:Aged; D058491:Bacterial Load; D004731:Endotoxins; D005260:Female; D017583:Hemodiafiltration / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D015312:Hemodialysis Solutions / Q000737:chemistry; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
D004731:Endotoxins; D015312:Hemodialysis Solutions