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Continuous arteriovenous and intermittent hemofiltration in renal failure
1Department of Internal Medicine, University Hospital, Uppsala, Sweden.
Scandinavian Journal of Urology and Nephrology. Supplementum
|January 1, 1990
Summary
This study evaluates vascular access devices and hemofiltration techniques for renal failure patients. While Hemasite showed promise, thrombosis and infection were issues; continuous hemodialysis (CAVHD) offered better uremic control than continuous arteriovenous hemofiltration (CAVH).
Area of Science:
- Nephrology
- Vascular Surgery
- Critical Care Medicine
Background:
- Continuous arteriovenous and intermittent hemofiltration (CAVH/IHF) have advanced renal failure treatment beyond traditional hemodialysis (HD).
- Reliable vascular access is crucial for these therapies, yet chronic HD/HF patients frequently experience access issues.
- Acute renal failure (ARF) management requires effective vascular access and appropriate treatment modalities.
Purpose of the Study:
- To assess the efficacy and safety of a needleless prosthetic vascular access device (Hemasite) in chronic HD/HF patients.
- To evaluate the outcomes of different acute vascular access methods in ARF patients.
- To compare continuous arteriovenous hemofiltration (CAVH) with continuous hemodialysis (CAVHD) for ARF treatment and assess antibiotic pharmacokinetics during IHF.
Main Methods:
- A five-year follow-up of 32 Hemasite devices in 28 chronic HD/HF patients.
- Evaluation of vascular access methods (Buselmeier shunt, femoral catheters, Scribner shunt) in 76 ARF patients.
- Outcome analysis of CAVH in 40 ARF patients and a comparison of CAVH versus CAVHD in 13 ARF patients; pharmacokinetic study of imipenem/cilastatin during IHF.
Main Results:
- Hemasite provided reliable access with adequate blood flow; one-year survival was 55%, with thrombosis and infection as primary failure causes.
- Buselmeier shunt was most common (75%) for ARF acute access, offering adequate flow and ease of manipulation.
- CAVHD demonstrated superior uremic control compared to CAVH in ARF, with lower ultrafiltration volumes; 75% of imipenem/cilastatin was eliminated during IHF.
Conclusions:
- The Hemasite device is a viable alternative for vascular access, though implant loss due to thrombosis and infection requires attention.
- Buselmeier shunt is a safe and effective option for acute vascular access in ARF.
- CAVHD is a preferred modality over CAVH for uremic control in ARF, and dose adjustments are necessary for antibiotics like imipenem/cilastatin during IHF.