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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

Kaplan-Meier analysis of hospital survival rates after CVVHDF versus SHDF. ( ): number of subjects alive.
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fig2: Kaplan-Meier analysis of hospital survival rates after CVVHDF versus SHDF. ( ): number of subjects alive.

Mentions: Although the length of ICU stay was not significantly different between the two arms, the length of hospital stay was significantly shorter in the SHDF arm than the CVVHDF arm (Table 5). The primary study outcome, survival until discharge from the ICU or for 30 d, whichever was earlier, was 76.0% in the CVVHDF arm and 88.0% in the SHDF arm (no significant difference). There was no significant difference in the ICU survival rate and hospital survival rate between the two arms (Figure 2). However, the total number of patients who showed renal recovery was significantly higher in the SHDF arm than in the CVVHDF arm, and significant differences were detected in the number of surviving patients showing renal recovery at the time of discharge from the ICU or from the hospital (Table 5). In addition, 16% of patients in the CVVHDF arm and 8% of those in the SHDF arm were transitioned to IHD while in the ICU (no significant difference).


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)

Kaplan-Meier analysis of hospital survival rates after CVVHDF versus SHDF. ( ): number of subjects alive.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig2: Kaplan-Meier analysis of hospital survival rates after CVVHDF versus SHDF. ( ): number of subjects alive.
Mentions: Although the length of ICU stay was not significantly different between the two arms, the length of hospital stay was significantly shorter in the SHDF arm than the CVVHDF arm (Table 5). The primary study outcome, survival until discharge from the ICU or for 30 d, whichever was earlier, was 76.0% in the CVVHDF arm and 88.0% in the SHDF arm (no significant difference). There was no significant difference in the ICU survival rate and hospital survival rate between the two arms (Figure 2). However, the total number of patients who showed renal recovery was significantly higher in the SHDF arm than in the CVVHDF arm, and significant differences were detected in the number of surviving patients showing renal recovery at the time of discharge from the ICU or from the hospital (Table 5). In addition, 16% of patients in the CVVHDF arm and 8% of those in the SHDF arm were transitioned to IHD while in the ICU (no significant difference).

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