ACUTE DIALYTIC SUPPORT FOR THE CRITICALLY .3. INTERMITTENT HEMODIALYSIS VERSUS CONTINUOUS ARTERIOVENOUS HEMODIAFILTRATION

There is still debate about whether continuous renal replacement thera py is superior to intermittent hemodialysis (IHD) as dialytic support for the critically ill patient with acute renal failure, mainly becaus e of lack of comparative data. We sought to address this issue by revi ewing the medical records of such patients admitted to a single surgic al intensive care unit treated with either continuous arteriovenous he modiafiltration (CAVHD) or IHD between January 1, 1986, and August 31, 1993. Of 94 consecutive patients who received dialytic support for se vere acute renal failure, 34 (36%) patients were treated with IHD and 60 (64%) patients with CAVHD. The patients were comparable in terms of age or gender and represented a similar case mix. Patients treated wi th CAVHD were more severely ill as manifested by a lower mean arterial pressure (75 +/- 3 vs. 86 +/- 5 mm Hg; p < 0.05), higher Apache II sc ore (26.5 +/- 0.5 vs. 22.2 +/- 0.3; p < 0.05), and a higher number of organ system failures (3.4 +/- 0.2 vs. 2.6 +/- 0.3; p < 0.05). Despite greater illness severity and a higher probability of death (55 +/- 2. 6 vs. 33 +/- 2.5%; p < 0.0001), in those treated with CAVHD, no differ ence in outcome was observed between groups: CAVHD 26/60 (43%) vs. IHD 20/34 (59%; NS). The mean Apache II score of patients treated with CA VHD who survived was similar to that of patients treated with IHD who died (24.5 +/- 0.3 vs. 24.2 +/- 0.4; NS). CAVHD was associated with im proved hemodynamic stability, better control of fluid balance and bioc hemistry, increased nutritional intake, and a shorter duration of acut e renal failure (p < 0.05). Our data suggest that CAVHD offers several distinct advantages over IHD which may translate in improved survival , particularly in the more severely ill patients.