Acute hemodialysis in the surgical intensive care unit

Records of postoperative patients requiring acute hemodialysis admitted to the surgical intensive care unit from January 1, 1984 to June 30, 1986 were retrospectively reviewed. Twenty one patients, 9 men and 12 women (mean age 72 years) had an overall mortality of 86 per cent. The mortality rate with impaired preoperative renal function (Ccr less than 41 ml/min) was 100 per cent versus 80 per cent for patients with normal clearances. Prior to the onset of renal failure nine patients (43%) experienced hypotension and seven (33%) received nephrotoxic drugs or dyes. Blood culture documented sepsis was uniformly fatal. Any additional organ system failure (cardiac, pulmonary, hepatic or hematologic) adversely affected survival (P less than 0.01). Nineteen of twenty patients (95%) were fluid overloaded (mean 10.0L) at dialysis institution, determined by measured output over input. Commonly observed cardiac and/or pulmonary system failure is exacerbated by overhydration, therefore early dialysis and/or judicious fluid restriction may be preventative and could improve survival.