Continuous hemodialysis for the treatment of acute renal failure

Introduction. Continuous replacement therapy of renal function has gained a cceptance over the last decade for the treatment of acute renal failure. In the present study we present our experience using continuous hemodialysis (CHD) in our institution. Patients and methods. This is a prospective analy sis of the CHD treated patients in, the intensive care unit (ICU) of our in stitution over an 24-month period. CHD was performed through a double-lumen catheter such as Mahurkar. We have performed 28 CHD procedures in 28 patie nts, from which four were excluded from the analysis. Three patients were e xcluded as CHD lasted less than 12 hours and one patient because he had chr onic renal failure. The studied variables were: heart and respiratory rate, mean arterial pressure, body temperature, APACHE II classification status, arterial gasomery, cell blood count, BUN, creatinine, serum electrolytes, and hepatic enzymes. We also registered urine output, diuretic use, and the mean dose of inotropic drugs employed per day. These variables were obtain ed at the admittance to the ICU, before the initiation of CHD and after 24 and 48 hours. We also registered age, gender, and final evolution. Results. We evaluated 24 patients with mean age of 58.1 +/- 17.5 years in which CHD was use for a mean time of 4.6 +/- 2.8 days. Total ultrafiltrate was 19.5 +/- 8.4 liters, for a mean, of 4.2 liters per day. CHD resulted in improvem ent of heart and respiratory rate, mean arterial pressure and laboratory va riables such as arterial pH, bicarbonate concentration, BUN and potassium. It also decreased significant by the use of inotropic drugs. Five out of tw enty-four patients survived (20.8%). The survived patients had significant lower age than the died patients (39.2 +/- 20 years us. 63 +/- 13.3; p < 0. 001), lower rime between the admittance to ICU and the beginning of CHD (1. 4 +/- 0.5 days vs. 3.5 +/- 2.6; p < 0.01) and lower APACHE II classificatio n at admittance to ICU (7.4 +/- 2.6 vs. 19.0 +/- 2.7; p < 0.001) and at the start of CHD (13.6 +/- 3.2 vs. 24.7 +/- 3.7; p < 0.001). However, multivar iate analysis revealed that the only variable associated with a better surv ival was a lower time between the admittance to intensive care and the begi nning of CHD. Discussion. CHD is a safe technique that can be used for acut e renal failure patients who have contraindications for intermittent HD. Th is technique can be used in hospitals offering intermittent hemodialysis an d intensive care. CHD use is associated with improvement of hemodynamic and metabolic alterations in patients with shock. Our data support the concept that the earlier the initiation of CHD the better the prognosis.