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  • Title: Continuous arterial-venous hemodiafiltration in critically ill patients.
    Author: Voerman HJ, Strack van Schijndel RJ, Thijs LG.
    Journal: Crit Care Med; 1990 Sep; 18(9):911-4. PubMed ID: 2394114.
    Abstract:
    Intermittent hemodialysis in critically ill patients is often accompanied by circulatory instability and hypotension. This may hamper the removal of fluid. Therefore, slow, continuous arterial-venous hemodiafiltration (CAVHD), using the patient's arterial-venous pressure difference, was developed. In 17 critically ill patients with acute renal failure, CAVHD was initiated. Most patients (n = 13) suffered from septic shock. Five (29%) patients survived and in six (35%), renal function was recovered. Average length of treatment was 15 days. The filter life was 52 h. When a dialysate rate of 1600 ml/h was employed, urea clearance was sufficient and hemodialysis was no longer needed as compared with a dialysate rate of 800 ml/h. Hyponatremia developed in all but one patient, but was more severe in the group treated with a dialysate fluid containing 132 mmol/L Na. After using a dialysate with a higher Na content of 140 mmol/L, the average serum Na concentration was 131 mmol/L. Convective Na transport by ultrafiltration was probably responsible for most of the Na loss. In 13 (76%) patients, thrombocytopenia was present. In one patient a hematoma developed in the groin, but could be controlled by local pressure. It is concluded that CAVHD is a safe technique that might replace intermittent hemodialysis in critically ill patients.
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