The typical annual expenditure for patients requiring continuous hemof
iltration (CHF) is high. To audit the benefit of this expensive treatm
ent, the outcome of 48 consecutive patients (34 men, 14 women; mean ag
e, 65 years) requiring hemofiltration for acute renal failure was anal
yzed during a period of 24 months. The operations performed were 26 CA
BG, 8 AVR, 3 AVR/MVR, 2 post infarction VSD repairs, and 1 thoracoabdo
minal aneurysmectomy. Indications for hemofiltration were oliguria and
fluid overload in 69%, uremia in 56%, acidosis in 33%, and hyperkemia
in 13%. Twenty five patients (52%) died while in the hospital, and 10
more died within 9 months of discharge. Of the remaining 13 survivors
, 6 (46%) were classified as III or IV according to the New York Heart
Association classification system. The mean ITU and hospital stay per
patient requiring CHF was 15.3 days and 25.4 days, respectively. Ther
e were no statistically significant differences between patients who d
id and did not survive in the hospital in age, pre-operative renal fun
ction, ejection fraction, duration of cardiopulmonary bypass, or urine
output before CHF. However, there were no survivors when the cardiac
index was less than 1.7 L/m(2) and adrenalin requirement was more than
30 mu g/min before CHF (seven patients). These results suggest that t
he short- and long-term outcome in patients requiring CHF after cardia
c surgery is poor. Considering the large demand on resources, the use
of CHF should be rationalized, particularly in patients with persisten
t low cardiac output.