A Prospective Comparative Study of Continuous Arteriovenous Hemodiafiltration and Continuous Venovenous Hemodiafiltration in Critically Ill Patients

Bellomo, Rinaldo; Parkin, Geoffrey; Love, Jim; Boyce, Neil

doi:10.1016/s0272-6386(12)80268-x

Cited by 78 publications

(41 citation statements)

References 11 publications

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“…Nine percent reported use of arteriovenous therapies, either as their exclusive modality of CRRT or in addition to use of venovenous therapy, despite the widespread availability of equipment for venovenous CRRT and the markedly lower rate of vascular complications with venovenous therapy (11). There was substantial variation in the reported modalities of CRRT used, with greater use of diffusive as compared with convective therapies.…”

Section: Discussionmentioning

confidence: 99%

Management of Renal Replacement Therapy in Acute Kidney Injury

Overberger¹,

Pesacreta

Palevsky

et al. 2007

Clinical Journal of the American Society of Nephrology

107

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Background: Data on current practices for management of renal replacement therapy (RRT) in acute kidney injury (AKI) are limited, particularly with regard to the dosing of therapy.Design, setting, participants, and measurements: A survey was conducted of practitioners at the 27 study sites that participate in the Veterans Affairs/National Institutes of Health Acute Renal Trial Network (ATN) Study before initiation of patient enrollment for ascertainment of the local prevailing practices for management of RRT in critically ill patients with AKI. Surveys were returned from 130 practitioners at 26 of 27 study sites; the remaining study site provided aggregate data.Results: Intermittent hemodialysis and continuous RRT were the most commonly used modalities of RRT, with sustained low-efficiency dialysis and other "hybrid" treatments used in fewer than 10% of patients. Intermittent hemodialysis was most commonly provided on a thrice-weekly or every-other-day schedule, with only infrequent assessment of the delivered dosage of therapy. Most practitioners reported that they did not dose continuous RRT on the basis of patient weight. The average prescribed dosage of therapy corresponded to a weight-based dosage of no more than 20 to 25 ml/kg per h.Conclusions: These results provide insight into clinical management of RRT and provide normative data for evaluation of the design of ongoing clinical trials.

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Section: Discussionmentioning

confidence: 99%

Management of Renal Replacement Therapy in Acute Kidney Injury

Overberger¹,

Pesacreta

Palevsky

et al. 2007

Clinical Journal of the American Society of Nephrology

107

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“…6 A number of studies have attempted to determine whether choice of RRT mode affects outcome. [13][14][15][16][17][18][19][20][21] However, even meta-analyses of these studies have provided conflicting results. 22,23 Major confounding factors have been inability of some patients randomized to the IHD arms to tolerate therapy due to hemodynamic instability or the exclusion of patients with baseline hemodynamic instability from some studies.…”

Section: Résultats : Pendant La Période éTudiée 116 Patients Atteintmentioning

confidence: 99%

Continuous renal replacement therapy improves renal recovery from acute renal failure

Jacka

Ivancinova

Gibney

2005

Can J Anesth/J Can Anesth

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B Ba ac ck kg gr ro ou un nd d: : Acute renal failure (ARF) occurs in up to 10% of critically ill patients, with significant associated morbidity and mortality. The optimal mode of renal replacement therapy (RRT) remains controversial. This retrospective study compared continuous renal replacement therapy (CRRT) and intermittent hemodialysis (IHD) for RRT in terms of intensive care unit (ICU) and hospital mortality, and renal recovery. M Me et th ho od ds s: :We reviewed the records of all patients undergoing RRT for the treatment of ARF over a 12-month period. Patients were compared according to mode of RRT, demographics, physiologic characteristics, and outcomes of ICU and hospital mortality and renal recovery using the Chi square, Student's t test, and multiple logistic regression as appropriate.R Re es su ul lt ts s: : 116 patients with renal insufficiency underwent RRT during the study period. Of these, 93 had ARF. The severity of illness of CRRT patients was similar to that of IHD patients using APACHE II (25.1 vs 23.5, P = 0.37), but they required significantly more intensive nursing (therapeutic intervention scale 47.8 vs 37.6, P = 0.0001). Mortality was associated with lower pH at presentation (P = 0.003) and increasing age (P = 0.03). Renal recovery was significantly more frequent among patients initially treated with CRRT (21/24 vs 5/14, P = 0.0003). Further investigation to define optimal timing, dose, and duration of RRT may be beneficial.C Co on nc cl lu us si io on ns s: : Although further study is needed, this study suggests that renal recovery may be better after CRRT than IHD for ARF. Mortality was not affected significantly by RRT mode.

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“…Treatment modalities included continuous haemofiltration, either arteriovenous [23,26,28-32,37,45,-46,50-53,59], venovenous [36,38,47,49,60,66] or both [34,35,44,55], slow continuous ultrafiltration [6], continuous haemodialysis, either arteriovenous [39,41,54,56,58,61,65,68], venovenous [25,31] or both [9,24,42,62,63], continuous haemodiafiltration [40,48,67,69] as well as both continuous arteriovenous haemofiltration and haemodialysis [43,57] respectively. In one study continuous RRT was combined with intermittent haemodialysis [29].…”

mentioning

confidence: 99%

“…The types of niters used were mostly polyacrylonitrile [9,24,25,28,31,[33][34][35][37][38][39][40][41][42]48,53,58,61,65,66,[68][69][70], but also polysulphone [6,23,26,30,31,36,43,[49][50][51]57] or polyamide [32,44,46,47,51,55,56,58,70] niters have been used. In some studies the type of filter prescribed was not indicated.…”

mentioning

confidence: 99%

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Does continuous renal replacement therapy favourably influence the outcome of the patients?

Jakob

Frey

Uehlinger

1996

Nephrology Dialysis Transplantation

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Continuous haemodialysis and continuous haemofiltration are efficient and safe techniques for the treatment of acute renal failure. Theoretical advantages are improved haemodynamic stability and easier fluid removal. All 15 available studies comparing intermittent (522 patients) with continuous (651 patients) renal replacement therapy have been reviewed. From these studies it cannot be established, whether the use of a continuous instead of an intermittent treatment modality improves the outcome in patients with acute renal failure. Reviewing all 67 published studies dealing with continuous renal replacement therapy revealed a trend to a decreasing mortality rate (/><0.08) over the last 11 years, whereas the mean age and the severity of illness of the patients, measured by the APACHE II score, did not change. In order to establish whether the quality of treatment has improved as a function of time, two quality factors (QF) were created, i.e. QF for age (mean age/mean mortality rate of the patients treated) and QF for severity of diseases (mean APACHE II/mean mortality rate). Both QF improved from 1984 until 1994, when analyzed for continuous (P< 0.001) or intermittent (P< 0.001) treatment modality. Thus the quality of treatment of patients with acute renal failure improved during the last decade. However, there is no evidence with respect to survival rate that a continuous renal replacement therapy is superior to an intermittent one.

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A Prospective Comparative Study of Continuous Arteriovenous Hemodiafiltration and Continuous Venovenous Hemodiafiltration in Critically Ill Patients

Cited by 78 publications

References 11 publications

Management of Renal Replacement Therapy in Acute Kidney Injury

Management of Renal Replacement Therapy in Acute Kidney Injury

Continuous renal replacement therapy improves renal recovery from acute renal failure

Does continuous renal replacement therapy favourably influence the outcome of the patients?

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