Venovenous continuous renal replacement therapy for burned patients with acute renal failure

From 1995 to 1998, 12 burned patients with acute renal failure (ARF) were t reated by venovenous continuous renal replacement therapy (CRRT) at the Bur n Unit of Hotel-Dieu de Montreal. Their mean (+/-SD) age was 51 +/- 12 year s, and the mean burned surface covered 48.6 +/- 15.8% of total body surface area. All patients were mechanically ventilated and presented evidence of sepsis. The mean delay before occurrence of ARF was 15 +/- 6 days and ARF w as mainly related to sepsis and hypotension. Main reasons for CRRT initiati on were;azotemia and fluid overload. A total of 15 CRRT modalities were app lied (12 continuous venovenous hemodiafiltration, CVVHDF, two continuous ve no venous hemofiltration, CVVH: and one continuous veno-venous hemodialysis , CVVHD) over 14 +/- 13 days. For CRRT, nine patients received heparin and three were not anticoagulated. Mean values for dialysate and reinjection fl ow rates were 1134 +/- 250 ml/h and 635 +/- 327 ml/h, respectively. Admission weight was 78.8 +/- 12.7 kg with a mean weight gain before CRRT i nitiation of 10.0 +/- 5.8 kg and a mean weight loss during CRRT of 8.9 +/- 5.5 kg. Nine patients received enteral plus parenteral nutrition, and three , parenteral nutrition only; the total caloric intake was 31.5 +/- 7.0 kcal /kg/day and protein intake, 1.8 +/- 0.4 g/kg/day. The normalized protein ca tabolic rate (nPCR) was evaluated at 2.28 +/- 0.78 g/kg/day during CRRT. Th e mortality rate was 50%. The six survivors all recovered normal renal func tion with four of them requiring intermittent hemodialysis for short period s. In conclusion, veno venous CRRT is particularly well suited for this sel ected population allowing smooth fluid removal and aggressive nutritional s upport. (C) 2000 Elsevier Science Ltd and ISBI. All rights reserved.