[Beneficial effects of continuous hemodiafiltration after cardiac surgery in patients with chronic renal failure]

From December 1993 to June 1996, fourteen patients with chronic renal failure (CRF) were underwent cardiac surgery. Thirteen of them had coronary artery bypass grafting (CABG) and one patient had aortic valve replacement. We employed continuous hemodiafiltration (CHDF) with or without peritoneal dialysis in eleven cases in the early postoperative course of open heart surgery. In these cases, the usefulness of CHDF were examined. CHDF was started after 16.9 +/- 13.7 hours of surgery, and continued for 31.9 +/- 18.0 hours. We adjusted blood flow as 80 ml/min, perfusate flow of hemofilter as 500 ml/hr, and the activated clotting time (ACT) as 150-200 seconds with heparin or nafamostat mesilate. No hemorrhagic tendency was observed. Mean serum creatinine level before and after 24 hours of CHDF was 5.6 +/- 2.2 and 5.6 +/- 2.1 mg/dl respectively, and it was not elevated. The average removal volume was 2,223 +/- 1,256 ml for the first 24 hours, and pulmonary wedge pressure was decreased from 9.0 +/- 2.3 to 6.4 +/- 3.0 mmHg (p < 0.05). However, there was no significant change at cardiac output before and after CHDF. Total dose of dopamine and dobutamine were unchanged. No significant change were noted at systemic vascular resistance and pulmonary vascular resistance. We conclude that CHDF allows an adequate removal of fluid and waste products without deleterious effects on hemodynamics even in patients after cardiac surgery. CHDF is a safe and effective alternative in patients with CRF after cardiac surgery.