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      Severe Acute Renal Failure: A Comparison of Acute Continuous Hemodiafiltration and Conventional Dialytic Therapy

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          Abstract

          It is unknown whether continuous renal replacement techniques result in diminished morbidity and mortality when compared to conventional dialytic techniques. To investigate this issue a previously described, retrospectively studied group of critically ill patients with severe acute renal failure treated by conventional dialysis (CD) was compared to a prospectively studied group of similar patients treated by acute continuous hemodiafiltration (ACHD). A combined retrospective and prospective clinical and laboratory investigation was carried out for 234 consecutive critically ill patients with severe acute renal failure in the intensive care unit of a tertiary institution. Biochemical, clinical and outcome data in all patients treated by conventional dialytic techniques (intermittent hemodialysis and/or peritoneal dialysis) during a 5-year period were retrospectively analyzed, and a prospective analysis of the same biochemical, clinical and outcome data in all patients treated by acute continous hemodiafiltration was done over a similar time span, with statistical comparison of findings. One hundred and fifty patients were treated by ACHD and 84 by CD. ACHD patients were more severely ill (mean APACHE II score: 28.2 vs. 25.8; p < 0.01) and older (mean age: 59.9 vs. 55.5 years; p < 0.01). There were no significant differences in the incidence of sepsis, bacteremia and need for mechanical ventilation. ACHD resulted in better control of uremia (mean steady-state plasma urea level: 20.1 vs. 31.7 mmol/l; p < 0.001) and hyperphosphatemia (mean serum phosphate: 1.26 vs. 1.95 mmol/l) after 24 h of initiation of therapy. It also allowed the administration of full nutritional support in a significantly greater percentage of patients (91.3 vs. 64.8%; p < 0.001). Survival to ICU discharge was significantly greater in ACHD patients (43.3 vs. 29.8%; p < 0.05), but survival to hospital discharge was not statistically different (ACHD: 38.6% vs. CD: 29.8%; n.s.). When survival to hospital discharge was corrected for illness severity, patients with an intermediate degree of illness severity (APACHE score between 19 and 29) were more likely to survive if treated with ACHD rather than CD (50.6 vs. 30%; p < 0.025). ACHD survivors had a shorter mean ICU stay (11.8 vs. 16.9 days; p < 0.05) and a shorter mean duration of hospital stay (33.9 vs. 58.4 days; p < 0.001). The findings of this study suggest that, in critically ill patients, ACHD may provide better control of uremia and a greater ability to administer full nutritional support than CD. They also suggest that the use of ACHD is associated with a shorter duration of ICU and hospital stay and may even provide a survival advantage. The current study invites further investigation of the use of continuous hemofiltration techniques in the critically ill.

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          Author and article information

          Journal
          NEF
          Nephron
          10.1159/issn.1660-8151
          Nephron
          S. Karger AG
          1660-8151
          2235-3186
          1995
          1995
          18 December 2008
          : 71
          : 1
          : 59-64
          Affiliations
          Department of Medicine, Monash Medical Centre, Melbourne, Vic, Australia
          Article
          188675 Nephron 1995;71:59–64
          10.1159/000188675
          8538850
          © 1995 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 6
          Categories
          Original Paper

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