CONTINUOUS HEMOFILTRATION AND HEMODIAFILTRATION FOR ACUTE-RENAL-FAILURE IN SEVERELY BURNED PATIENTS

Among 970 burned patients admitted between April 1987 and September 19 94, 16 (1.6 per cent) presented acute renal failure requiring dialytic support adn were treated by continuous renal replacement therapy as f irst-line modality. Their mean burned surface area was 58.0 +/- 5.7 pe r cent. Acute renal failure mainly occurred in the second week followi ng admission in relation to sepsis and nephrotoxic drugs. Four types o f continuous renal replacement therapy were performed: continuous arte riovenous haemofiltration ann haemodiafiltration (CAVH and CAVHDF) and continuous venovenous haemofiltration and haemodiafiltration (CVVH an d CVVHDF). Compared to 33 critically ill patients without burns also t reated for acute renal failure by continuous haemofiltration or haemod iafiltration during the same period, the mean duration of therapy was longer for the burned patients (24.2 +/- 9.4 vs. 5.3 +/- 0.8 days). Al though mean urine outputs and ultrafiltration rates were similar for b oth groups, fluid administration was higher for burned patients (8.2 /- 0.7 vs. 3.3 +/- 0.2 l/day). Total weight loss during therapy was si gnificantly greater in burned patients (12.6 +/- 3.6 vs. 6.8 +/- 1.0 k g), in relation to longer treatment period. Bleeding complications wer e more frequent in burned patients (56 vs. 15 per cent). Mortality rat es were similar in both groups (82 vs. 82 per cent). bl conclusion, wh en aggressive initial fluid resuscitation is applied following burn in jury, the occurrence of acute renal failure is low, delayed and multif actorial. Since they are haemodynamically well tolerated and provide a good metabolic and volaemic control, continuous renal replacement the rapies appear to be useful modalities for burned patients with acute r enal failure. However, as bleeding complications are more frequent, ca reful monitoring is necessary. (C) 1997 Elsevier Science Ltd or ISBI.