Blood Purification
Original Paper
Treatment of Sepsis-Associated Severe Acute Renal Failure with Continuous Hemodiafiltration: Clinical Experience and Comparison with Conventional DialysisBellomo R. · Farmer M. · Wright C. · Parkin G. · Boyce N.Department of Medicine, Monash Medical Centre, Melbourne, Australia
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Article / Publication Details
Accepted: August 08, 1994
Published online: October 30, 2008
Issue release date: 1995
Number of Print Pages: 9
Number of Figures: 0
Number of Tables: 0
ISSN: 0253-5068 (Print)
eISSN: 1421-9735 (Online)
For additional information: https://www.karger.com/BPU
Abstract
The syndrome of sepsis-associated severe acute renal failure is a frequent component of sepsis-induced multiorgan failure. Continuous hemofiltration techniques are often used in its dialytic management but little is known about their impact. The aim of this study is to define the biochemical and clinical impact of continuous hemodiafiltration (CHD) in the management of this syndrome and to retrospectively compare it to that of conventional dialysis. A prospective, cohort study and retrospective comparison with historical controls was conducted at an intensive care unit (ICU) of a tertiary institution. Eighty-seven consecutive septic patients with acute renal failure were treated by continuous hemodiafiltration and 40 consecutive similar patients by conventional dialysis. All new cases of severe acute renal failure with sepsis were treated by means of continuous hemodiafiltration. Historical controls were treated by means of conventional dialysis. Illness and sepsis severity were assessed on admission and prior to initiation of teatment. Biochemical variables were assessed daily. Outcome was measured as discharge from the ICU, duration of oliguria and discharge from hospital. Of the 87 patients treated by hemodiafiltration, 86 had multiorgan failure, 71(81.6 %) septic shock and 52 (59.8%) bacteremia/fungemia. Their APACHE II score on admission was 29.9 and their mean organ failure score prior to treatment was 4.3. Hemodiafiltration resulted in a significant fall in mean urea and creatinine levels within 24 h and in the correction of acidosis. The mean alveolar-arterial gradient fell from 276 to 211 mm Hg (p < 0.02) within 24 h of therapy. Complications were few and mostly related to vascular access. Hemodynamic stability was maintained throughout all of the 18,122 h of treatment. Thirty-one (35.6%) patients survived to hospital discharge. Comparison with conventionally treated historical controls showed better control of uremia at 24 h. Among patients with an APACHE II score < 30, survival was greater with hemodiafiltration (51.2 vs. 26.6%; p < 0.05). This was also true for patients with 4 or fewer failing organs (53.1 vs. 26.9%; p < 0.05). Continuous hemodiafiltration achieves rapid and reliable control of uremia and acidosis in spesis-associated severe acute renal failure and is associated with improved gas exchange. Survival in these extremely ill patients approached 35%. The use of hemodiafiltration is associated with better early control of uremia than with conventional hemodialysis or peritoneal dialysis. In some patient subgroups, continuous hemodiafiltration also appears to provide a survival advantage. The above findings suggest that continuous hemodiafiltration may be a form of renal replacement therapy ideally suited to the management of sepsis-associated severe acute renal failure.
© 1995 S. Karger AG, Basel
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Article / Publication Details
Accepted: August 08, 1994
Published online: October 30, 2008
Issue release date: 1995
Number of Print Pages: 9
Number of Figures: 0
Number of Tables: 0
ISSN: 0253-5068 (Print)
eISSN: 1421-9735 (Online)
For additional information: https://www.karger.com/BPU
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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