ACETATE-FREE BIOFILTRATION FOR ACUTE-RENAL-FAILURE

The characteristics of acetate-free biofiltration (AFB) are now well d ocumented in patients with chronic renal failure: hemodynamic toleranc e, correction of acid-base imbalance, buffer-free dialysate (without a cetate) and absence of backfiltration. This hemodialysis technique can be beneficial to patients with acute renal failure (ARF). In our inte nsive care unit, we prospectively studied 29 patients with isolated AR F or ARF associated with failure of other organs. All eligible patient s were randomly assigned to undergo dialysis with bicarbonate hemodial ysis (BH) or with (AFB). All used the same high flux biocompatible dia lysis membranes. Effectiveness and hemodynamic tolerance of hemodialys is sessions and evolution of patients were analyzed. Correction of met abolic disorders, although better in the AFB group was not statistical ly different from that in the BH group. Re-equilibration of acid-base balance was also similar, with or without mechanical ventilation. Hepa rin consumption was significantly higher in the AFB group, with no eff ect on haemorrhagic complications Analysis of hypo- and hypertensive e pisodes, defined as arterial pressure (AP) variations 20% greater than initial pressure, showed no difference in terms of number or degree o f AP variation. However, weight loss and the rate of ultrafiltration l ed to a higher hypotensive risk in the BP group (p < 0.05). Finally, t he clinical course and prognosis was similar in both groups. In summar y, AFB may be considered as effective a hemodialysis technique as BH i n patients with ARF. Weight loss was better tolerated in the AFB group and can be a favorable factor considering the deleterious effect of o verhydratation in patients admitted to an intensive care unit. This st udy invites a comparison of longer dialysis session of AFB therapy and continuous hemodiafiltration.