Continuous high volume venous-venous haemofiltration in acute renal failure

Abstract

Continuous, high volume, venous-venous haemofiltration was used as renal support in 28 critically ill patients with acute renal failure. Fifteen patients survived and were subsequently discharged from the ITU. Although haemofiltration was highly effective in reducing the blood urea and serum creatinine, only survivors demonstrated a significant increase in arterial pH (medians before and at two days 7.28 and 7.49 respectively, p less than 0.005) with a reduction in severity of their illness (median APACHE II scores before and at two days 23 and 16, p less than 0.005). Patients who died remained severely ill and acidotic (median APACHE II scores before and at two days 26 and 28; median arterial pH values 7.32 and 7.31 respectively) and by day two of treatment, marked differences between the patient groups in APACHE II scores, mean arterial pressure, arterial pH and urine flow rate had developed. Haemofiltration with the correction of acute uraemia alone does not necessarily lead to a reduction in the severity of illness which in the critically ill more frequently reflects other organ dysfunction.

Sustained Low Efficiency Dialysis in the Continuous Mode (C-SLED)

“…Our finding that severity of illness factors such as multiorgan failure, hypotension or acidosis was a strong and independent predictor of survival on CRRT is not new or unexpected (12). Our finding that extremely low BUN level in patients receiving C-SLED may be a predictor of higher mortality risk is, however, new and of interest.…”

Renal replacement therapy review

“…[94][95][96] Failure to resolve acidosis during RRT is associated with increased mortality, hence this choice is important. [96][97][98] Lactate is noted to rise during lactate-based RRT and may have deleterious cardiovascular side effects and is associated with poor outcomes. 95,96,[98][99][100][101] It is unclear whether lactate induces injury or is simply a marker of dysoxia and abnormal liver metabolism of lactate during critical illness hence its association with mortality.…”

Cardiac output measurement and continuous venovenous haemofiltration

“…A number of variables have been shown to affect the accuracy of such measurements [2], including the rewarming of injectate from handling prior to injection [3], hypothermia [4] and concurrent peripheral intravenous fluid administration (51. CVVH is now increasingly used for renal support in the intensive care setting offering advantages of cardiovascular stability in those patients with multiorgan failure or shock [6]. It may however be a potential source of error in cardiac output measurements by thermodilution.…”

“…The RLMA is inserted and the mouth gag applied as per tonsillectomy [3,6]. The risk of airway fire is low since the operation site is remote from the LMA.…”