HEMODYNAMICS AND SURVIVAL OF PATIENTS WITH ACUTE-RENAL-FAILURE TREATED BY CONTINUOUS DIALYSIS WITH 2 SYNTHETIC MEMBRANES

Synthetic membranes are not identical and have specific interactions t hat may be harmful or beneficial. We have investigated the incidence o f hypotension and the outcome of acute renal failure (ARF) in ventilat ed patients treated by continuous venovenous dialysis with 2 different synthetic membranes. In Study 1, the mean arterial pressure (MAP) and systemic vascular resistance (SVR) were monitored during the first 12 min of dialysis with polyacrylonitrile (PAN). In Study 2, the MAP and survival rates were compared in patients randomly assigned to either PAN or polysulfone. No subjects were receiving angiotensin converting enzyme inhibitors. In Study 1, the MAP decreased due to a reduction in the SVR during the first 6 min of dialysis but returned to the baseli ne value by 12 min in 22 patients during 27 dialysis treatments. In St udy 2, the MAP was lower than the baseline value at 6 min during 233 d ialysis treatments in 133 patients randomly assigned to PAN or polysul fone membranes (PAN group, 81.5 +/- 15 to 78.7 +/- 15.6 mm Hg, p = 0.0 01; and polysulfone group, 81.3 +/- 15.4 to 80.0 +/- 15.7 mm Hg, p = 0 .06). Severe reductions in the MAP were seen during 13.2% of the PAN a nd 7.2% of the polysulfone treatments (chi(2), P = NS). The age, APACH E II score, MAP, inotrope requirement, and primary diagnosis did not d iffer according to membrane material in a total of 197 consecutive pat ients (PAN, n = 97; polysulfone, n = 100). Patient survival was 29% (P AN) and 27% (polysulfone). In multivariate analysis, APACHE II score, inotrope requirement, and liver failure were significant determinants of survival. In conclusion, PAN and polysulfone membranes were not dif ferent with respect to hypotensive reactions or survival in critically ill patients undergoing continuous venovenous hemodialysis.