CONTINUOUS HEMODIAFILTRATION DURING AND AFTER CARDIOPULMONARY BYPASS IN RENAL-FAILURE PATIENTS

Purpose: Continuous haemodiafiltration (CHDF) is a technique enhancing the efficiency of solute clearance of continuous haemofiltration by i nfusing dialysis fluid through the haemofilter, it has been reported t o control water and electrolyte balance continuously without haemodyna mic instability in critically ill patients with renal failure. Therefo re, we used CHDF during and after cardiopulmonary bypass (CPB) in two renal failure patients, and discuss its efficacy, Clinical features: T he first patient undergoing aortic valve replacement had dialysis-depe ndent renal failure. Chronic renal failure in the second patient under going mitral valve replacement and coronary revascularization was cont rolled preoperatively with diuretics. In both cases CHDF was performed not only during CPB but also in the post-CPB period, Serum concentrat ions of potassium, urea and creatinine were well-controlled in spite o f large amount of blood transfused in the post-CPB period (1000 ml fre sh blood and 400 ml fresh frozen plasma in the fist patient, and 1400 ml fresh blood in the second patient). There was no difficulty in haem ostasis during the use of nafamostat mesilate as an anticoagulant to k eep activated clotting time at about 150 sec for CHDF in the post-CPB period. Conclusion: Our initial experiences of CHDF during and after C PB suggest that technique provides excellent electrolyte, metabolite a nd fluid management for the cardiac patients with chronic renal failur e. Combined with nafamostat mesilate for anticoagulation, CHDF was sim ple-and safe and did not increase the risk of bleeding.