Accelerated venovenous hemofiltration: early technical and clinical experience

Area of Science:

• Nephrology
• Critical Care Medicine
• Renal Replacement Therapy

Background:

• Continuous renal replacement therapies (CRRTs) are essential for hemodynamically unstable patients but often require anticoagulation and long treatment durations.
• These limitations can complicate staffing and interfere with patient care.
• Accelerated venovenous hemofiltration (AVVH) was developed as an alternative using higher blood flow rates for shorter treatment periods without anticoagulation.

Purpose of the Study:

• To evaluate the technical and clinical experience of accelerated venovenous hemofiltration (AVVH) as an alternative renal replacement therapy.
• To assess the efficacy and safety of AVVH in hemodynamically unstable intensive care unit patients.

Main Methods:

• A case series design was employed.
• The study included hemodynamically unstable patients in medical or surgical intensive care units requiring renal replacement therapy.
• Outcomes measured included achieved dose, blood flow rate, mean arterial pressure, serum chemistry, patient weight, filter clotting, and survival.

Main Results:

• 457 AVVH treatments were performed on 100 patients over 5.6 days, with a mean blood flow of 362 mL/min and 9-hour treatment duration.
• No anticoagulation was used, and filter clotting occurred in only 3.3% of treatments.
• AVVH demonstrated significant reductions in blood urea nitrogen and creatinine, decreased patient weight, and maintained mean arterial pressure, with an overall patient survival rate of 53%.

Conclusions:

• Accelerated venovenous hemofiltration (AVVH) is a viable alternative renal replacement therapy for intensive care unit patients.
• AVVH provides effective volume and solute control without the need for anticoagulation.
• The accelerated treatment period enhances flexibility for staffing and patient management.