CONTINUOUS VENOVENOUS HIGH-FLUX DIALYSIS IN MULTIORGAN FAILURE - A 5-YEAR SINGLE-CENTER EXPERIENCE

The objective of this study was to determine the outcome of acute rena l failure (ARF) treated by continuous venovenous high-flux dialysis in patients with ventilator-dependent respiratory failure treated in a s ingle center and to examine the importance of primary diagnosis in det ermining survival. We retrospectively reviewed 408 consecutively treat ed patients in the multidisciplinary intensive care unit (ICU) of a la rge teaching hospital. All ventilated patients requiring dialysis supp ort over a 5-year period (January 1, 1991 to December 31, 1995) were i ncluded in the study. Patient age, APACHE II score, primary diagnosis, inotrope requirement, and survival to discharge from the ICU, from th e hospital, and at 6 months were recorded for 408 consecutively treate d patients. The mean age was 54 years, the median APACHE II score was 29, and the ICUs, hospital, and 6-month survival rates were 48%, 38%, and 36%, respectively. Inotropic support was required in 75%. Liver di sease was the primary diagnosis in 35%. Logistic regression analysis i ndicated that increasing age and APACHE II, use of inotropes, and pres ence of liver disease were all associated with increased mortality. Ei ght percent of survivors (3% of the total population) required long-te rm renal replacement therapy. In conclusion, in our experience, contin uous venovenous high-flux dialysis can be universally adopted in the I CU management of ARF associated with multiorgan failure. Patient survi val is related to primary diagnosis, and a knowledge of case mix is es sential in considering outcome of ARF in any reported series. (C) 1998 by the National Kidney Foundation, Inc.