Acute renal failure after open heart surgery: clinical experience with continuous arteriovenous hemodialysis

Continuous arteriovenous hemodialysis (CAVHD) was employed in five patients who suffered from acute renal failure (ARF) after open heart surgery during the period from July 1991 to February 1992. All patients had a urine output of less than 400 mL/24h and clinical evidence of fluid overload. Most of the patients needed respiratory support for respiratory insufficiency and required vasopressor infusions. They could not tolerate conventional hemodialysis due to severe hemodynamic instability, and the concurrent thoracic surgery precluded the application of peritoneal dialysis. All patients tolerated the CAVHD well, despite persistent hypotension. The mean age of the five patients was 53.6 +/- 15.3 years. The duration of CAVHD treatment ranged from 1.5 to 22 days. Whole blood clearances for urea, creatinine and phosphate were 13.27 +/- 1.86 mL/min, 13.05 +/- 3.12 mL/min, and 13.99 +/- 2.61 mL/min, respectively. According to the clinical condition, ultrafiltration averaged 100-200 mL/h; up to 1 L/h could be obtained without difficulty. In these situations, large concurrent amounts of vasopressors and nutritional fluids could be easily prescribed without fear of fluid overload. The introduction of CAVHD allowed a more stabilized environment for gradual recovery of the temporarily compromised ventricular function after open heart surgery. Later, the hemodynamic status was stabilized without or with only minimal infusions of vasopressors in all five patients. Renal function recovered in four patients and one was shifted to conventional hemodialysis. All five patients survived under CAVHD treatment. There were no significant complications related to the application of CAVHD.(ABSTRACT TRUNCATED AT 250 WORDS)