Continuous Arteriovenous Haemodialysis in Critically Ill Patients

Stevens, P. E.; Davies, Simon P.; Ea, Brown; Riley, Benita; Gower, P. E.; Kox, W. J.

doi:10.1016/s0140-6736(88)90695-2

Cited by 65 publications

(19 citation statements)

References 6 publications

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“…Since the clearance rates achieved were much greater than those of CAVHF alone, patients with hypercatabolic acute renal fail ure could be managed without the resource to additional conventional haemodialysis treatments [8], In these early reports the direction of the dialysate flow through the dialyzer was countercurrent to the blood flow [7,8], as during conventional machine haemodialysis. Subsequently, reports advo cating the use of CAVHD have either failed to mention the direction of the dialysate flow [9], or have used concurrent flow [10], To determine whether the direction of the dialy sate flow has any effect on the efficiency of CAVHD. we studied 3 patients established on CAVHD.…”

Section: Introductionmentioning

confidence: 99%

Effect of the Direction of Dialysate Flow on the Efficiency of Continuous Arteriovenous Haemodialysis

Davenport

Will

Davison³

1990

Blood Purif

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We have investigated the effect of the direction of the dialysate flow during continuous arteriovenous haemodialysis. Under similar conditions countercurrent flow was more efficient than concurrent flow in terms of both urea clearance, (mean ± SEM), 23.5 ± 0.5 compared to 18.4 ± 0.4 ml/min (p < 0.001) and creatinine clearance, 21.1 ± 0.5 compared to 15.6 ± 0.4 ml/min (p < 0.001). There was a greater drop in pressure along the blood compartment of the haemodiafilter during countercurrent flow, 16 ± 0.8 compared to 13 ± 0.3 mm Hg (p < 0.05) during concurrent flow, and this was associated with a greater ultrafiltration rate, 7.2 ± 0.6 compared to 6.0 ± 0.5 ml/min. The differences in diffusion, back diffusion and convection between the two systems resulted in a net gain of lactate/ bicarbonate and a net loss of chloride during countercurrent dialysate flow, and a net loss of lactate/bicarbonate with a gain of chloride during concurrent flow. These losses would have to be corrected in the clinical setting of patients who had been continuously treated by these systems for several days.

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Section: Introductionmentioning

confidence: 99%

Effect of the Direction of Dialysate Flow on the Efficiency of Continuous Arteriovenous Haemodialysis

Davenport

Will

Davison³

1990

Blood Purif

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“…In practice, the dialysis component (typically with dialysate flow 0.5-2 L/hr) is used for correction of uremia and hyperkalemia, whereas the filtration component is used for net fluid removal [47][48][49]. Earlier reports suggested that the presence of dialpate reduced the transmembrane hydrostatic pressure gradient and consequently the UF rate [2 51.…”

Section: Strctioiz M and Tmentioning

confidence: 99%

Continuous Renal Replacement Therapy for Critically Ill Patients: An Update

Bommel

Leunissen

Weimar

1994

J Intensive Care Med

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Despite continuous progress in intensive care during the last decades, the outcome of critically ill patients in whom acute renal failure (ARF) develops is still poor. This outcome may be explained partially by the frequent occurrence of ARF as part of multiple organ systems failure (MOSF). In this complex and unstable patient population, the provision of adequate renal support with either intermittent hemodialysis or peritoneal dialysis may pose major problems. Continuous renal replacement therapy (CRRT) is now increasingly accepted as the preferred treatment modality in the management of ARF in these patients. The technique offers adequate control of biochemistry and fluid balance in hemodynamically unstable patients, thereby enabling aggressive nutritional and inotropic support without the risk of exacerbating azotemia or fluid overload. In addition, experimental and clinical data suggest that CRRT may have a beneficial influence on hemodynamics and gas exchange in patients with septic shock and (nonrenal) MOSF, independent of an impact on fluid balance. We review both technical and clinical aspects of various continuous therapies, including their impact on serum drug levels and nutrient balance. In addition, an attempt is made to clarify the possible beneficial role of CRRT in reducing patient morbidity and mortality in the ICU.

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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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Continuous Arteriovenous Haemodialysis in Critically Ill Patients

Cited by 65 publications

References 6 publications

Effect of the Direction of Dialysate Flow on the Efficiency of Continuous Arteriovenous Haemodialysis

Effect of the Direction of Dialysate Flow on the Efficiency of Continuous Arteriovenous Haemodialysis

Continuous Renal Replacement Therapy for Critically Ill Patients: An Update

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

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