Continuous arteriovenous hemodialysis: outcome in intensive care acute renal failure patients

The clinical outcome of continuous arteriovenous hemodialysis (CAVHD), an alternative to continuous arteriovenous hemofiltration (CAVH) in our intensive care units (ICU) in Uppsala, was evaluated for 2 years. Forty-three patients were included. Pretreatment serum urea and creatinine levels (mean +/- SD) were 36 +/- 13 mmol/l and 420 +/- 147 mumol/l, and during treatment, steady-state levels were 25 +/- 10 mmol/l and 333 +/- 120 mumol/l, respectively (p < 0.0001). On top of acute renal failure (ARF), some patients had multiple organ failure that made it necessary to use mechanical respiration (63%), vasopressor drugs (74%) and aortic balloon pump therapy (5%). The outcome of this treatment was 60% when overall survival was considered. Higher dialysate flow rates (i.e., 25 ml/min) were applied in some patients in whom serum urea levels were persistently rising. The result of this was a notable decrease in the urea and creatinine serum levels. From the results of this 2-year experience, we have found CAVHD a promising alternative to CAVH that can be used as a treatment of choice for ARF in critically ill ICU patients.