title: Effect of early and intensive continuous venovenous hemofiltration on patients with cardiogenic shock and acute kidney injury after cardiac surgery.
abstract: OBJECTIVE
  Continuous renal replacement therapy (CRRT) is currently the mainstay renal support for critically ill patients. However, the optimal intensity of CRRT remains debated owing to the heterogeneity of the study populations and CRRT techniques across centers. The present study investigated the beneficial effects of early and intensive continuous venovenous hemofiltration (CVVH) on patients with shock after cardiotomy.
  
  
  METHODS
  Patients who had received CRRT for cardiogenic shock and acute kidney injury after cardiac surgery from January 2003 to December 2007 were retrospectively recruited. They were divided into 2 groups according to the delivered dosage of hemofiltration.
  
  
  RESULTS
  The mean duration between intensive care unit admission and initiation of CVVH was 1.4±0.8 days. The all-cause mortality by day 30 was 73.3% and 45.4% in the low- and high-dose groups, respectively (P=.002). The corresponding in-hospital mortality rate was 82.2% and 61.8% (P=.02). No significant difference was seen in the renal recovery of the survivors between the 2 groups.
  
  
  CONCLUSIONS
  In patients developing postoperative cardiogenic shock and acute kidney injury after cardiac surgery, an early higher CVVH dose was associated with better in-hospital and long-term survival. Moreover, the beneficial effect of intensive treatment might be more critical in the early perioperative period.
authors.affiliation: Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Szu-Yuan
authors.initials: SY
authors.lastname: Li
authors.affiliation: Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Wu-Chang
authors.initials: WC
authors.lastname: Yang
authors.affiliation: Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan. Electronic address: clchuang@vghtpe.gov.tw.
authors.forename: Chiao-Lin
authors.initials: CL
authors.lastname: Chuang
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000628:therapy*; D000368:Aged; D001774:Blood Chemical Analysis; D006348:Cardiac Surgical Procedures; D016022:Case-Control Studies; D003422:Critical Care; D005260:Female; D006440:Hemofiltration / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome