[Continuous arteriovenous hemodialysis in critical patients with acute renal failure]

Continuous arteriovenous hemodialysis (CAVHD) offers a modified therapeutic approach for the patient with acute renal failure. The system is modified fron the CAVH write out method by adding two pumps to control the flow rate of the dialysis solution and to reduce the nursing load. The blood flow through the dialyzer is dependent on the net blood pressure gradient. Peritoneal dialysis or bicarbonate dialysate is infused through the dialysate ports utilizing both diffuse and convective transport for an average blood flow rate of 0.9 L/hour. The two pumps control the dialysate inflow and outflow rates. Ten patients with complications and acute renal failure were treated with CAVHD for periods ranging from 10 to 154 hours. Average urea clearance was 9.39 mL/min. Average creatinine clearance was 9.12 mL/min, and in stable patients, the mean BUN was maintained at 60 mg/dL and the mean serum creatinine level was 4.6 mg/dL. The average ultrafiltration rate obtained was 100 mL/hr and was adjusted for the body fluid condition. most patients tolerated CAVHD without further hemodynamic instability and did not develop serious complications. In conclusion, CAVHD is a safe and technically simple procedure, which is particularly suitable for hemodynamically unstable patients requiring fluid removal.