A RANDOMIZED CROSS-OVER COMPARISON OF THE HEMODYNAMIC-RESPONSE TO INTERMITTENT HEMODIALYSIS AND CONTINUOUS HEMOFILTRATION IN ICU PATIENTS WITH ACUTE-RENAL-FAILURE

Objective: To compare the hemodynamic response of ICU patients with ac ute renal failure of a 24-h continuous arteriovenous hemofiltration (C AVH) and that of patients with a 4-h intermittent hemodialysis (HD). D esign: Cross-over randomized clinical trial. The two periods to be com pared were a 24-h CAVH and the 24-h encompassing a 4-h HD. These two p eriods were separated by a 24-h wash-out period. Setting: Ten bed medi cosurgical ICU of a tertiary care center in Paris, France. Patients: I nclusion criterion was the requirement of replacement therapy for acut e renal failure in patients already submitted to mechanical ventilatio n. Interventions: CAVH was performed with Ringers' lactate used for re stitution and infused before the hemofilter. The ultrafiltrate output was maintained at around 15 ml/min, HD was performed with a bicarbonat e-buffered dialysate. Mean outcome measures: Mean arterial pressure (M AP), use of adrenergic drugs, and change in body weight during each pe riod. Results: Twenty-seven consecutive patients were included, 15 CAV H-HD and 12HD-CAVH. CAVH and HD allowed the same metabolic efficacy. N o hemodynamic parameter (MAP, amount of adrenergic drugs, change in bo dy weight) differed between the two methods. Conclusions: CAVH is equi valent to HD in terms of MAP and the use of vasopressive drugs and flu ids. Establishing the superiority of CAVH would require carefully cont rolled studies assessing either outcome or changes in tissue oxygenati on.