title: Effects of dialysis modality on blood loss, bleeding complications and transfusion requirements in critically ill patients with dialysis-dependent acute renal failure.
abstract: Blood loss and bleeding complications may often be observed in critically ill patients on renal replacement therapies (RRT). Here we investigate procedural (i.e. RRT-related) and non-procedural blood loss as well as transfusion requirements in regard to the chosen mode of dialysis (i.e. intermittent haemodialysis [IHD] versus continuous veno-venous haemofiltration [CVVH]). Two hundred and fifty-two patients (122 CVVH, 159 male; aged 61.5±13.9 years) with dialysis-dependent acute renal failure were analysed in a sub-analysis of the prospective randomised controlled clinical trial-CONVINT-comparing IHD and CVVH. Bleeding complications including severity of bleeding and RRT-related blood loss were assessed. We observed that 3.6% of patients died related to severe bleeding episodes (between group P=0.94). Major all-cause bleeding complications were observed in 23% IHD versus 26% of CVVH group patients (P=0.95). Under CVVH, the rate of RRT-related blood loss events (57.4% versus 30.4%, P=0.01) and mean total blood volume lost was increased (222.3±291.9 versus 112.5±222.7 ml per patient, P <0.001). Overall, transfusion rates did not differ between the study groups. In patients with sepsis, transfusion rates of all blood products were significantly higher when compared to cardiogenic shock (all P <0.01) or other conditions. In conclusion, procedural and non-procedural blood loss may often be observed in critically ill patients on RRT. In CVVH-treated patients, procedural blood loss was increased but overall transfusion rates remained unchanged. Our data show that IHD and CVVH may be regarded as equivalent approaches in critically ill patients with dialysis-dependent acute renal failure in this regard.
authors.affiliation: Department of Nephrology and Intensive Care Medicine and Department of Hepatology and Gastroenterology, Charite Universitatsmedizin, Berlin, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Pschowski
authors.affiliation: Department of Nephrology and Intensive Care Medicine, Charite Universitatsmedizin, Berlin, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Briegel
authors.affiliation: Department of Clinical Cardiology and Department of Cardiology and Center for Innovative Trials, Charite Universitatsmedizin, Berlin, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Von Haehling
authors.affiliation: Center for Stroke Research Berlin, Charite Universitatsmedizin, Berlin, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Doehner
authors.affiliation: Department of Nephrology and Intensive Care Medicine, Charite Universitatsmedizin, Berlin, Germany.
authors.forename: T O
authors.initials: TO
authors.lastname: Bender
authors.affiliation: Department of Hepatology and Gastroenterology, Charite Universitatsmedizin, Berlin, Germany.
authors.forename: U F
authors.initials: UF
authors.lastname: Pape
authors.affiliation: Department of Nephrology and Intensive Care Medicine, Charite Universitatsmedizin, Berlin, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Hasper
authors.affiliation: Department of Nephrology and Intensive Care Medicine, Charite Universitatsmedizin, Berlin, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Jörress
authors.affiliation: Department of Nephrology and Intensive Care Medicine, Charite Universitatsmedizin, Berlin, Germany.
authors.forename: J C
authors.initials: JC
authors.lastname: Schefold
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy*; D000328:Adult; D000368:Aged; D001803:Blood Transfusion; D016638:Critical Illness; D005260:Female; D006440:Hemofiltration / Q000009:adverse effects*; D006470:Hemorrhage / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*
keywords: AKI; acute kidney injury; continuous dialysis; multi-organ failure; septic shock; severe sepsis