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Comparison of sustained hemodiafiltration with acetate-free dialysate and continuous venovenous hemodiafiltration for the treatment of critically ill patients with acute kidney injury.

Abe M, Maruyama N, Matsumoto S, Okada K, Fujita T, Matsumoto K, Soma M - Int J Nephrol (2011)

Bottom Line: Both the number of patients who showed renal recovery (40.0% and 68.0%, CVVHDF and SHDF, resp.; P < .05), and the hospital stay length (42.3 days and 33.7 days, CVVHDF and SHDF, resp.; P < .05), significantly differed between the two treatments.Although the total convective volumes did not significantly differ, the dialysate flow rate was higher and mean duration of daily treatment was shorter in the SHDF treatment arm.Our results suggest that compared with conventional CVVHDF, more intensive renal support in the form of post-dilution SHDF with acetate-free dialysate may accelerate renal recovery in critically ill patients with AKI.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan.

ABSTRACT
We conducted a prospective, randomized study to compare conventional continuous venovenous hemodiafiltration (CVVHDF) with sustained hemodiafiltration (SHDF) using an acetate-free dialysate. Fifty critically ill patients with acute kidney injury (AKI) who required renal replacement therapy were treated with either CVVHDF or SHDF. CVVDHF was performed using a conventional dialysate with an effluent rate of 25 mL·kg(-1) · (h-1), and SHDF was performed using an acetate-free dialysate with a flow rate of 300-500 mL/min. The primary study outcome, 30 d survival rate was 76.0% in the CVVHDF arm and 88.0% in the SHDF arm (NS). Both the number of patients who showed renal recovery (40.0% and 68.0%, CVVHDF and SHDF, resp.; P < .05), and the hospital stay length (42.3 days and 33.7 days, CVVHDF and SHDF, resp.; P < .05), significantly differed between the two treatments. Although the total convective volumes did not significantly differ, the dialysate flow rate was higher and mean duration of daily treatment was shorter in the SHDF treatment arm. Our results suggest that compared with conventional CVVHDF, more intensive renal support in the form of post-dilution SHDF with acetate-free dialysate may accelerate renal recovery in critically ill patients with AKI.

No MeSH data available.


Related in: MedlinePlus

Changes in arterial blood pH and HCO3− concentration before and after treatment in the two treatment arms. *P < .01, **P < .001 versus CVVHDF.
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fig1: Changes in arterial blood pH and HCO3− concentration before and after treatment in the two treatment arms. *P < .01, **P < .001 versus CVVHDF.

Mentions: The RRT parameters are described in Table 4. The number of treatments performed per patient was not significantly different between the two arms. The number of treatment hours per day was significantly less in the SHDF arm than in the CVVHDF arm. The dialysate flow rate and total dialysate volumes were significantly higher in the SHDF arm (dialysate volume, 9.6 ± 1.6 L/session in the CVVHDF arm versus 189 ± 28 L/session in the SHDF arm; P < .0001). The total convective rate was higher in the SHDF arm than in the CVVHDF arm; however, because the duration of SHDF treatment was shorter, the total convective volumes were not significantly different between the two groups. Accounting for the effect of postdilution fluid replacement on solute clearance, the mean actual delivered dosage was 26.6 mL·kg−1·h−1 in the CVVHDF arm. There were instances in which RRT was interrupted by hemofilter thrombosis and catheter dysfunction; interruptions were observed significantly more frequently during CVVHDF (30.1% of sessions) than during SHDF (12.6% of sessions; P < .05). In 20 of the 203 CVVHDF treatments (9.8%), hypotension occurred that required discontinuation of the treatment (versus 12 of the 170 SHDF treatments [7.1%], P = .32). In 26 of the CVVHDF treatments (12.8%), initiation of vasopressor support was required (versus 18 for SHDF [10.5%], P = .48), and in 63 of the CVVHDF treatments (31.0%), other interventions were required because of treatment-associated hypotension (versus 44 for SHDF [25.8%], P = .19). As shown in Figure 1, the pH and HCO3− concentration of arterial blood was significantly increased after treatment compared to pretreatment in both arms. However, comparing between the two arms, pH and HCO3− concentration were higher in the SHDF arm compared to the CVVHDF arm both before and after treatment.


Comparison of sustained hemodiafiltration with acetate-free dialysate and continuous venovenous hemodiafiltration for the treatment of critically ill patients with acute kidney injury.

Abe M, Maruyama N, Matsumoto S, Okada K, Fujita T, Matsumoto K, Soma M - Int J Nephrol (2011)

Changes in arterial blood pH and HCO3− concentration before and after treatment in the two treatment arms. *P < .01, **P < .001 versus CVVHDF.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3108092&req=5

fig1: Changes in arterial blood pH and HCO3− concentration before and after treatment in the two treatment arms. *P < .01, **P < .001 versus CVVHDF.
Mentions: The RRT parameters are described in Table 4. The number of treatments performed per patient was not significantly different between the two arms. The number of treatment hours per day was significantly less in the SHDF arm than in the CVVHDF arm. The dialysate flow rate and total dialysate volumes were significantly higher in the SHDF arm (dialysate volume, 9.6 ± 1.6 L/session in the CVVHDF arm versus 189 ± 28 L/session in the SHDF arm; P < .0001). The total convective rate was higher in the SHDF arm than in the CVVHDF arm; however, because the duration of SHDF treatment was shorter, the total convective volumes were not significantly different between the two groups. Accounting for the effect of postdilution fluid replacement on solute clearance, the mean actual delivered dosage was 26.6 mL·kg−1·h−1 in the CVVHDF arm. There were instances in which RRT was interrupted by hemofilter thrombosis and catheter dysfunction; interruptions were observed significantly more frequently during CVVHDF (30.1% of sessions) than during SHDF (12.6% of sessions; P < .05). In 20 of the 203 CVVHDF treatments (9.8%), hypotension occurred that required discontinuation of the treatment (versus 12 of the 170 SHDF treatments [7.1%], P = .32). In 26 of the CVVHDF treatments (12.8%), initiation of vasopressor support was required (versus 18 for SHDF [10.5%], P = .48), and in 63 of the CVVHDF treatments (31.0%), other interventions were required because of treatment-associated hypotension (versus 44 for SHDF [25.8%], P = .19). As shown in Figure 1, the pH and HCO3− concentration of arterial blood was significantly increased after treatment compared to pretreatment in both arms. However, comparing between the two arms, pH and HCO3− concentration were higher in the SHDF arm compared to the CVVHDF arm both before and after treatment.

Bottom Line: Both the number of patients who showed renal recovery (40.0% and 68.0%, CVVHDF and SHDF, resp.; P < .05), and the hospital stay length (42.3 days and 33.7 days, CVVHDF and SHDF, resp.; P < .05), significantly differed between the two treatments.Although the total convective volumes did not significantly differ, the dialysate flow rate was higher and mean duration of daily treatment was shorter in the SHDF treatment arm.Our results suggest that compared with conventional CVVHDF, more intensive renal support in the form of post-dilution SHDF with acetate-free dialysate may accelerate renal recovery in critically ill patients with AKI.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan.

ABSTRACT
We conducted a prospective, randomized study to compare conventional continuous venovenous hemodiafiltration (CVVHDF) with sustained hemodiafiltration (SHDF) using an acetate-free dialysate. Fifty critically ill patients with acute kidney injury (AKI) who required renal replacement therapy were treated with either CVVHDF or SHDF. CVVDHF was performed using a conventional dialysate with an effluent rate of 25 mL·kg(-1) · (h-1), and SHDF was performed using an acetate-free dialysate with a flow rate of 300-500 mL/min. The primary study outcome, 30 d survival rate was 76.0% in the CVVHDF arm and 88.0% in the SHDF arm (NS). Both the number of patients who showed renal recovery (40.0% and 68.0%, CVVHDF and SHDF, resp.; P < .05), and the hospital stay length (42.3 days and 33.7 days, CVVHDF and SHDF, resp.; P < .05), significantly differed between the two treatments. Although the total convective volumes did not significantly differ, the dialysate flow rate was higher and mean duration of daily treatment was shorter in the SHDF treatment arm. Our results suggest that compared with conventional CVVHDF, more intensive renal support in the form of post-dilution SHDF with acetate-free dialysate may accelerate renal recovery in critically ill patients with AKI.

No MeSH data available.


Related in: MedlinePlus