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Bernd Grabensee - One of the best experts on this subject based on the ideXlab platform.

  • citrate plasma levels in patients under regional anticoagulation in Continuous venovenous Hemofiltration
    American Journal of Kidney Diseases, 2006
    Co-Authors: Gerd R Hetzel, Bernd Grabensee, Gediz Taskaya, Christoph Sucker, Marcus G Hennersdorf, Michael Schmitz
    Abstract:

    Background: Different methods of regional anticoagulation using citrate in Continuous Hemofiltration have been described. To date, only such surrogate parameters as pH, anion gap, total calcium concentration, or total calcium-ionized calcium ratio have been proposed to reflect increased plasma citrate levels and thus risk for side effects. However, none of these parameters has been correlated with plasma citrate levels in critically ill patients. Methods: Sixteen patients were treated with Continuous venovenous Hemofiltration (CVVH) and citrate anticoagulation for a mean of 13 ± 9 days. Citrate levels were measured every other day, and correlations were calculated with the mentioned parameters. Results: Steady-state citrate levels on treatment day 3 were 16.39 ± 15.77 mg/dL (range, 2.63 to 73.49 mg/dL [853 ± 821 μmol/L; range, 137 to 3825 μmol/L]). The highest correlation was found between citrate plasma level and total calcium-ionized calcium ratio ( R = 0.85; P R = −0.15) and anion gap ( R = 0.36) were not helpful in estimating citrate plasma levels in patients treated with citrate-CVVH. Conclusion: Calculating total calcium-ionized calcium ratio is a simple tool that correlates best with citrate plasma levels. We recommend close monitoring of this parameter in all patients administered high doses of citrate as part of regional anticoagulation protocols.

  • the use of different buffers during Continuous Hemofiltration in critically ill patients with acute renal failure
    Intensive Care Medicine, 1999
    Co-Authors: P Heering, Katrin Ivens, O Thumer, S Morgera, M P Heintzen, Jutta Passlickdeetjen, R Willers, B E Strauer, Bernd Grabensee
    Abstract:

    Objective: To determine the impact of different Hemofiltration (HF) replacement fluids on the acid-base status and cardiovascular hemodynamics in patients with acute renal failure (ARF) and Continuous veno-venous Hemofiltration (CVVH).¶Design: Prospective, cohort study.¶Setting: Intensive Care Unit of the Heinrich Heine University Hospital, Dusseldorf, Germany.¶Subject and methods: One hundred and thirty-two critically ill patients with acute renal failure and Continuous veno-venous HF were studied. Fifty-two patients were subjected to lactate-based (group 1), and 32 to acetate-based Hemofiltration (group 2)while 48 (group 3) were treated with bicarbonate-based buffer Hemofiltration fluid. Fifty-seven had a septic, and 75 a cardiovascular, origin of the ARF. Creatinine, blood urea nitrogen (BUN), serum bicarbonate, arterial pH, lactate and Apache II scores were noted daily.¶Main results: The mean CVVH duration was 9.8 ± 8.1 days, mortality was 65 %. No difference was present between the groups under investigation with regard to the main clinical parameters. Lactate- and bicarbonate-based Hemofiltration led to significantly higher serum bicarbonate and arterial pH values as compared to the acetate-based Hemofiltration. Serum bicarbonate values at 48 h after the initiation of CVVH treatment were 25.7 ± 3.8 mmol/l (p < 0.001) in group 1, 20.6 ± 3.1 mmol/l in group 2 and 23.3 ± 3.9 mmol/l (p < 0.001) in group 3. While a lack of increase in serum bicarbonate and arterial pH was correlated to poor prognosis in lactate- and bicarbonate-based Hemofiltration, no such observation was made in acetate-based Hemofiltration. Cardiovascular hemodynamics were superior in patients treated with lactate- and bicarbonate-based buffer solution as compared to those treated with acetate-based buffer solution.¶Conclusions: The degree of correction of acidosis during Hemofiltration was determined by patient outcome in patients treated with lactate- and bicarbonate-based buffer solutions, but not in patients receiving acetate-buffered solution. Bicarbonate and lactate-based buffer solutions were found to be superior to acetate-based replacement fluid.

  • cytokine removal and cardiovascular hemodynamics in septic patients with Continuous venovenous Hemofiltration
    Intensive Care Medicine, 1997
    Co-Authors: P Heering, S Morgera, R Willers, B E Strauer, F J Schmitz, G Schmitz, H P Schultheiss, Bernd Grabensee
    Abstract:

    Objectives: To determine whether Continuous venovenous Hemofiltration leads to extraction of tumor necrosis factor alpha (TNFα) and cytokines from the circulation of critically ill patients with sepsis and acute renal failure and to quantitate the clearance and the removal rate of these cytokines and their effect on serum cytokine concentrations. Design: Prospective, controlled study in patients with Continuous venovenous Hemofiltration (24 l/24 h) using a polysulphone membrane in patients with acute renal failure. Patients: 33 ventilated patients with acute renal failure of septic (n = 18) and cardiovascular origin (n = 15) were studied. Interventions: Hemodynamic monitoring and collection of blood and ultrafiltrate samples before and during the first 72 h of Continuous Hemofiltration. Measurements and main results: Cardiovascular hemodynamics (Swan-Ganz catheter), Acute Physiology and Chronic Health Evaluation II score, creatinine, electrolytes, and blood urea nitrogen were recorded daily. Cytokines (TNFα, TNFα-RII, interleukin (IL) 1β , IL1RA, IL2, IL2R, IL6, IL6R, IL8, IL10) were measured in prefilter blood and in ultrafiltrate immediately preceding and 12, 24, 48, and 72 h after initiating Continuous venovenous Hemofiltration (CVVH). Septic patients showed elevated cardiovascular values for cardiac output (7.2 ± 2.1 l/min), cardiac index (4.2 ± 1.3 l/min per m2), and stroke volume (67 ± 23 ml) and reduced values for systemic vascular resistance (540 ± 299 dyn · s · cm− 5). All hemodynamic values normalized within the first 24 h after initiating CVVH treatment. TNFα was 1833 ± 1217 pg/ml in septic patients and 42.9 ± 6.3 pg/ml in nonseptic patients (p < 0.05) prior to CVVH. TNFα was detected in ultrafiltrate but did not decrease in blood during treatment with CVVH. There was no difference in IL 1β between septic (3.8 ± 1.9 pg/ml) and nonseptic patients (1.7 ± 0.5 pg/ml). No significant elimination of cytokines was achieved in the present study by CVVH treatment. Conclusions: These findings demonstrate that CVVH can remove TNFα and special cytokines from the circulation of critically ill patients. Cardiovascular hemodynamics seemed to improve in septic patients after induction of Hemofiltration treatment, although there was no evidence that extracorporeal removal of cytokines achieved a reduction in blood levels. The study indicates that low volume Continuous Hemofiltration with polysulphone membranes in patients with acute renal failure is not able to induce significant removal of cytokines.

Claudio Ronco - One of the best experts on this subject based on the ideXlab platform.

  • interpreting the mechanisms of Continuous renal replacement therapy in sepsis the peak concentration hypothesis
    Artificial Organs, 2003
    Co-Authors: Claudio Ronco, Ciro Tetta, Filippo Mariano, Mary Lou Wratten, Monica Bonello, Valeria Bordoni, Ximena Cardona, Paola Inguaggiato, Lidia Pilotto, Vince Dintini
    Abstract:

    Severe sepsis and septic shock are the primary causes of multiple organ dysfunction syndrome (MODS), which is the most frequent cause of death in intensive care unit patients. Many water-soluble mediators with pro- and anti-inflammatory action such as TNF, IL-6, IL-8, and IL-10 play a strategic role in septic syndrome. In intensive care medicine, blocking any one mediator has not led to a measurable outcome improvement in patients with sepsis. CRRT is a Continuously acting therapy, which removes in a nonselective way pro- and anti-inflammatory mediators; "the peak concentration hypothesis" is the concept of cutting peaks of soluble mediators through Continuous Hemofiltration. Furthermore, there is evidence of increased efficacy of high-volume Hemofiltration compared to conventional CVVH, and other blood purification techniques that utilize large-pore membranes or sorbent plasmafiltration are conceptually interesting.

  • a phase ii randomized controlled trial of Continuous Hemofiltration in sepsis
    Critical Care Medicine, 2002
    Co-Authors: Louise Cole, Rinaldo Bellomo, Graeme K Hart, Didier Journois, Piers Davenport, Peter G Tipping, Claudio Ronco
    Abstract:

    Objective To study the effect of early and Continuous venovenous Hemofiltration (CVVH) on the plasma concentrations of several humoral mediators of inflammation and subsequent organ dysfunction in septic patients. Design Randomized, controlled trial. Setting Intensive care unit of a tertiary hospital. Patients Twenty-four patients with early septic shock or septic organ dysfunction. Interventions Random allocation to receive 48 hrs of isovolemic CVVH at 2 L/hr of fluid exchange or no Hemofiltration. Measurements and main results We measured the plasma concentrations of complement fractions C3a and C5a, interleukins 6, 8, and 10, and tumor necrosis factor alpha at baseline and 2, 24, 26, 48, and 72 hrs. A multiple organ dysfunction score (MODS) was calculated daily for each patient until death or discharge from the intensive care unit. The concentrations of most mediators decreased between baseline and 72 hrs. Some significant falls in concentration could be identified between specific time points, but CVVH was not associated with an overall reduction in any plasma cytokine concentrations. There was also no difference between the mean cumulative MODS for control survivors (43.3 +/- 19.7) and CVVH survivors (33.2 +/- 19.0; p = .30), and no difference between the average MODS calculated for all controls (4.1 +/- 1.9) and all CVVH subjects (3.3 +/- 1.7; p = .26). CVVH did not improve oxygenation, lower the platelet count, or reduce the duration of vasopressor support and mechanical ventilation. Conclusions Early use of CVVH at 2 L/hr did not reduce the circulating concentrations of several cytokines and anaphylatoxins associated with septic shock, or the organ dysfunction that followed severe sepsis. CVVH using current technology cannot be recommended as an adjunct to the treatment of septic shock unless severe acute renal failure is present.

  • changing acute renal failure treatment from intermittent hemodialysis to Continuous Hemofiltration impact on azotemic control
    International Journal of Artificial Organs, 1999
    Co-Authors: Rinaldo Bellomo, Michael Farmer, S Bhonagiri, Sandro V Porceddu, M Ariens, D Mpisi, Claudio Ronco
    Abstract:

    Background. Continuous renal replacement therapy is increasingly used in the management of acute renal failure in critically ill patients. The advantages of Continuous renal replacement therapy (CRRT) over intermittent hemodialysis (IHD), however, are not yet fully documented. In particular, it is unknown whether Continuous veno-venuous hemodiafiltration (CVVHDF) provides better control of azotemia than IHD.

Bruce A. Mueller - One of the best experts on this subject based on the ideXlab platform.

  • ex vivo ceftolozane tazobactam clearance during Continuous renal replacement therapy
    Blood Purification, 2017
    Co-Authors: Weerachai Chaijamorn, Alexander R Shaw, Susan J Lewis, Bruce A. Mueller
    Abstract:

    Background/Aims: To determine ceftolozane/tazobactam transmembrane clearances (CLTM) in Continuous Hemofiltration (CHF) and Continuous hemodialysis (CH

  • Tedizolid clearance by in vitro Continuous renal replacement therapy model
    Critical Care, 2015
    Co-Authors: Susan J Lewis, Lynn A. Switaj, Bruce A. Mueller
    Abstract:

    Tedizolid is an oxazolidinone antibiotic approved to treat acute bacterial skin and soft tissue infection and is under investigation for treatment of nosocomial pneumonia, common in critically ill patients with acute kidney injury. There are limited data on tedizolid disposition in Continuous renal replacement therapy (CRRT). This study's purpose was to assess Continuous Hemofiltration (CHF) and Continuous hemodialysis (CHD) influence on tedizolid clearance.

  • tedizolid adsorption and transmembrane clearance during in vitro Continuous renal replacement therapy
    Blood Purification, 2015
    Co-Authors: Susan J Lewis, Lynn A. Switaj, Bruce A. Mueller
    Abstract:

    Background/Aims: To study transmembrane clearance (CLTM) and adsorption of tedizolid, a novel oxazolidinone antibiotic, in Continuous Hemofiltration (C

  • Telavancin and Hydroxy Propyl-β-Cyclodextrin Clearance during Continuous Renal Replacement Therapy: An in vitro Study:
    The International journal of artificial organs, 2009
    Co-Authors: Jignes H Patel, Steven L Barriere, Marianne D Churchwell, Julie D. Seroogy, Maricor Grio, Bruce A. Mueller
    Abstract:

    BACKGROUND/AIMS Telavancin is a lipoglycopeptide antimicrobial agent which has been approved in Europe and has been recently FDA approved in the United States. Telavancin's parenteral solution contains hydroxy propyl-beta -cyclodextrin (HP-beta -CD) to enhance its solubility. The disposition of telavancin and HP-beta -CD during Continuous renal replacement therapies (CRRT ) has not been previously reported. METHODS The transmembrane clearances (CLtm ) of telavancin and HP-beta -CD during Continuous Hemofiltration and hemodialysis were assessed using an in vitro bovine blood model with AN69 and polysulfone hemodiafilters at varying ultrafiltrate and dialysate flow rates (1, 2, 3, & 6 l/hr). RESULTS The mean telavancin sieving coefficient ranged from 0.25 to 0.31 during Continuous Hemofiltration. At all ultrafiltration rates, no differences were observed in telavancin CLtm between the two hemodiafilter types. For Continuous hemodialysis, mean telavancin saturation coefficients ranged from 0.10 to 0.43 and CLtm tended to be higher for the polysulfone hemodiafilter than the AN69 hemodiafilter, especially at higher flow rates. Mean HP-beta -CD sieving coefficients ranged from 0.63 to 1.03 and saturation coefficients from 0.63 to 1.38, resulting in a CLtm that was similar to ultrafiltrate and dialysate flow rates. CONCLUSION Telavancin CLtm is dependent on hemodiafilter type, dialysate and ultrafiltration rates. CRRT with high ultrafiltrate or dialysate rates may result in sufficient telavancin clearance to alter telavancin dosing. HP-beta -CD clearance by Continuous hemodialysis or Continuous Hemofiltration is substantial and may be sufficient to prevent HP-beta -CD accumulation in subjects receiving CRRT . Pharmacokinetic studies conducted in patients receiving CRRT and telavancin are needed to confirm these in vitro findings.

  • ertapenem clearance during modeled Continuous renal replacement therapy
    International Journal of Artificial Organs, 2008
    Co-Authors: James M Stevenson, Daryl D. Depestel, Fritz Sörgel, Martina Kinzig, Jignes H Patel, Marianne D Churchwell, A M Vilay, V Jakob, Bruce A. Mueller
    Abstract:

    PURPOSE To determine ertapenem transmembrane clearance (CLtm) during Continuous renal replacement therapy (CRRT) using a validated in vitro model. METHODS Ertapenem clearance during Continuous Hemofiltration and hemodialysis was assessed with AN69 and polysulfone hemodiafilters at 4 dialysate (Qd) and ultrafiltration rates (Quf): 1, 2, 3, and 6 l/hour. Blood and dialysate samples were collected at each flow rate and assayed for urea (control solute) and ertapenem concentrations. The experiment was repeated 5 times for each hemodiafilter type. Ertapenem and urea sieving coefficient (SC) and saturation coefficient (SA) were assessed, and CLtm calculated. RESULTS In Continuous Hemofiltration mode, urea and ertapenem SC ranged from 1.00 to 1.19 at all Quf and did not differ between hemodiafilter types. Consequently, convective CLtm also did not differ between hemodiafilters. In Continuous dialysis mode, urea Cltm did not differ between hemodiafilter types at any Qd. However, ertapenem SA and CLtm were significantly different between hemodiafilter types at Qd 6l/hour (p<0.001). As Qd increased, mean +/- SD AN69 SA declined significantly from 0.87 +/- 0.12 at Qd 1 l/hour to 0.45 +/- 0.02 at Qd 6 l/hour (p<0.001). Ertapenem SA did not differ at any Qd with the polysulfone hemodiafilter (range 0.71-0.80). CONCLUSION Ertapenem was cleared substantially in these in vitro CRRT models. However, our findings illustrate discordance between our observed SC and SA and the published unbound fraction of ertapenem. This finding has been reported with many other drugs, including carbapenem antibiotics. If in vivo studies corroborate our SA and SC findings, dosage adjustment for patients receiving CRRT will be required.

Rinaldo Bellomo - One of the best experts on this subject based on the ideXlab platform.

  • Continuous Hemofiltration for anasarca recovery of renal function after 71 liters of net ultrafiltration
    International Journal of Artificial Organs, 2008
    Co-Authors: John R Prowle, Rinaldo Bellomo, Jonathan Buckmaster, Geoffrey A Gutteridge, Graeme K Hart, Helen Ingrid Opdam, William Silvester, Stephen Warrillow
    Abstract:

    : We report on a 64-year-old female presenting with anasarca secondary to volume loading in the setting of chronic liver disease, acute on chronic renal failure, circulatory failure and sepsis. Over 37 days, a net negative fluid balance of 71 L was achieved using Continuous Hemofiltration, with spontaneous recovery of urine output, vasopressor independence and resolution of coagulopathy. This case report underlines the pathophysiological role of tissue edema in the downward spiral of hepato-renal and cardio-renal dysfunction and illustrates that very large volumes of tissue fluid can be safely and effectively removed with Continuous renal replacement therapy, thereby permitting recovery of organ function. To our knowledge, there have been no previous reports of such large volume net fluid removal by progressive ultrafiltration in the intensive care unit.

  • platelet loss across the hemofilter during Continuous Hemofiltration
    International Journal of Artificial Organs, 2003
    Co-Authors: J Mulder, Rinaldo Bellomo, Han Khim Tan, William Silvester
    Abstract:

    BACKGROUND Thrombocytopenia is a common finding in patients in the intensive care unit receiving Continuous renal replacement therapy (CRRT). It is unknown if the hemofilter itself contributes to the platelet loss. OBJECTIVE To measure the direct effect of the hemofilter on platelet counts during CRRT. DESIGN Prospective, observational study. SETTING Intensive care unit of a University hospital. PATIENTS Critically ill patients with acute renal failure receiving CRRT. METHODS Two samples of blood were drawn simultaneously, pre-filter and post-filter, and analyzed for platelet count. A correction factor was applied to the post-filter platelet count to adjust for the hemoconcentrating effect of net ultrafiltration. RESULTS Forty-eight sets of paired data from 22 patients were studied. There was a small but significant decrease in mean platelet count across the hemofilter. The mean platelet count drop was 2.32 x 10(9)/L (s.e. 1.06, p = 0.0487, 95% CI (0.01, 4.62)). Blood flow was strongly related to degree of platelet loss, with a decreased loss of 0.07 x 10(9)/L for every ml/min increase in blood flow (p = 0.015). There was no overall decrease in concurrently measured red cell counts across the hemofilter. However, there was a machine-specific affect on red cell loss (p < 0.0001). The total calculated daily platelet loss across the filter was 625 x 10(9) cells. CONCLUSION The hemofilter may contribute to the thrombocytopenia seen during CRRT, by means of either destruction or retention of platelets during passage. This affect appears attenuated by higher blood flows. This information is useful in the assessment of a low platelet count in patients receiving CRRT.

  • a phase ii randomized controlled trial of Continuous Hemofiltration in sepsis
    Critical Care Medicine, 2002
    Co-Authors: Louise Cole, Rinaldo Bellomo, Graeme K Hart, Didier Journois, Piers Davenport, Peter G Tipping, Claudio Ronco
    Abstract:

    Objective To study the effect of early and Continuous venovenous Hemofiltration (CVVH) on the plasma concentrations of several humoral mediators of inflammation and subsequent organ dysfunction in septic patients. Design Randomized, controlled trial. Setting Intensive care unit of a tertiary hospital. Patients Twenty-four patients with early septic shock or septic organ dysfunction. Interventions Random allocation to receive 48 hrs of isovolemic CVVH at 2 L/hr of fluid exchange or no Hemofiltration. Measurements and main results We measured the plasma concentrations of complement fractions C3a and C5a, interleukins 6, 8, and 10, and tumor necrosis factor alpha at baseline and 2, 24, 26, 48, and 72 hrs. A multiple organ dysfunction score (MODS) was calculated daily for each patient until death or discharge from the intensive care unit. The concentrations of most mediators decreased between baseline and 72 hrs. Some significant falls in concentration could be identified between specific time points, but CVVH was not associated with an overall reduction in any plasma cytokine concentrations. There was also no difference between the mean cumulative MODS for control survivors (43.3 +/- 19.7) and CVVH survivors (33.2 +/- 19.0; p = .30), and no difference between the average MODS calculated for all controls (4.1 +/- 1.9) and all CVVH subjects (3.3 +/- 1.7; p = .26). CVVH did not improve oxygenation, lower the platelet count, or reduce the duration of vasopressor support and mechanical ventilation. Conclusions Early use of CVVH at 2 L/hr did not reduce the circulating concentrations of several cytokines and anaphylatoxins associated with septic shock, or the organ dysfunction that followed severe sepsis. CVVH using current technology cannot be recommended as an adjunct to the treatment of septic shock unless severe acute renal failure is present.

  • early and intensive Continuous Hemofiltration for severe renal failure after cardiac surgery
    The Annals of Thoracic Surgery, 2001
    Co-Authors: Paul Bent, Rinaldo Bellomo, Jonathan Buckmaster, Geoffrey A Gutteridge, Graeme K Hart, William Silvester, Han Khim Tan, Laurie Doolan, George Matalanis, Jai Raman
    Abstract:

    Background. The aim of this study was to test whether early and intensive use of Continuous venovenous Hemofiltration (CVVH) achieved a better than predicted outcome in patients with severe acute renal failure undergoing cardiac operations, and whether a simple and yet accurate model could be developed to predict their outcome before starting CVVH. Methods. Medical record analysis with collection of demographic, clinical, and outcome information was used. Results. Sixty-five consecutive patients were treated with early and intensive CVVH (mean operation to CVVH time, 2.38 days; pump-controlled ultrafiltration rate, 2 L/h) after coronary artery bypass grafting (56.9%), single valve procedure (16.9%), or combined operations (26.2%). In 32.3% of patients, intraaortic balloon counterpulsation was required and 20% of patients were emergencies. Sustained hypotension despite inotropic and vasopressor support occurred in 40% of patients and prolonged mechanical ventilation in 58.5%. Using an outcome prediction score specific for acute renal failure, the predicted risk of death was 66%. Actual mortality was 40% (p = 0.003). Using multivariate logistic regression analysis and neural network analysis, patient outcome could be predicted with good levels of accuracy (receiver operating characteristic 0.89 and 0.9, respectively). Conclusions. Early and aggressive CVVH is associated with better than predicted survival in severe acute renal failure after cardiac operations. Using readily available clinical data, the outcome of such patients can be predicted before the implementation of CVVH.

  • brain density changes during renal replacement in critically ill patients with acute renal failure Continuous Hemofiltration versus intermittent hemodialysis
    Journal of Nephrology, 1999
    Co-Authors: C Ronco, Rinaldo Bellomo, Alessandra Brendolan, La Greca G
    Abstract:

    Computerized tomography (CT) studies of the brain were made on 12 patients with acute renal failure from different origin. Patients were treated for two subsequent days in random sequence with intermittent hemodialysis (HD) (one 4-h session and Kt/V > or = 1) and Continuous veno-venous Hemofiltration (CVVH) (one 24-h session and Kt/V > or = 1). CT scans were done before and after the HD and CVVH session in each patient. In baseline conditions, the only macroscopic morphological alteration was a slight brain edema in some patients. Significant changes in the density of white and gray matter were observed after the HD session in all patients (gray matter from 52.3 +/- 5.2 to 38.9 +/- 5.3 and white matter from 36.7 +/- 3.5 to 24.8 +/- 3.2 Hounsfield units, average delta -26.7%). No changes were observed after CVVH. We conclude that intermittent HD involves a remarkable degree of "unphysiology", leading to increased water content in the brain after each session. In acute patients this may lead to a post-dialytic brain edematogenic state. The physiological stability provided by Continuous therapies such as CVVH avoids this unwanted effect, and suggests that Continuous renal replacement therapies should be a first choice in these patients.

Jean Carlet - One of the best experts on this subject based on the ideXlab platform.

  • a randomized cross over comparison of the hemodynamic response to intermittent hemodialysis and Continuous Hemofiltration in icu patients with acute renal failure
    Intensive Care Medicine, 1996
    Co-Authors: Benot Misset, Jeanfranois Timsit, Sylvie Chevret, Bertrand Renaud, Fabienne Tamion, Jean Carlet
    Abstract:

    Objective To compare the hemodynamic response of ICU patients with acute renal failure of a 24-h Continuous arteriovenous Hemofiltration (CAVH) and that of patients with a 4-h intermittent hemodialysis (HD).

  • a randomized cross over comparison of the hemodynamic response to intermittent hemodialysis and Continuous Hemofiltration in icu patients with acute renal failure
    Intensive Care Medicine, 1996
    Co-Authors: Benot Misset, Jeanfranois Timsit, Sylvie Chevret, Bertrand Renaud, Fabienne Tamion, Jean Carlet
    Abstract:

    To compare the hemodynamic response of ICU patients with acute renal failure of a 24-h Continuous arteriovenous Hemofiltration (CAVH) and that of patients with a 4-h intermittent hemodialysis (HD). Cross-over randomized clinical trial. The two periods to be compared were a 24-h CAVH and the 24-h encompassing a 4-h HD. These two periods were separated by a 24-h wash-out period. Ten bed medicosurgical ICU of a tertiary care center in Paris, France. Inclusion criterion was the requirement of replacement therapy for acute renal failure in patients already submitted to mechanical ventilation. CAVH was performed with Ringers' lactate used for restitution and infused before the hemofilter. The ultrafiltrate output was maintained at around 15 ml/min. HD was performed with a bicarbonate-buffered dialysate. Mean arterial pressure (MAP), use of adrenergic drugs, and change in body weight during each period. Twenty-seven consecutive patients were included, 15 CAVH-HD and 12HD-CAVH. CAVH and HD allowed the same metabolic efficacy. No hemodynamic parameter (MAP, amount of adrenergic drugs, change in body weight) differed between the two methods. CAVH is equivalent to HD in terms of MAP and the use of vasopressive drugs and fluids. Establishing the superiority of CAVH would require carefully controlled studies assessing either outcome or changes in tissue oxygenation.