Treatment of Acute Renal Failure in Intensive Care Patients by Continuous Arteriovenous Hernofiltration (CAVH): Two Years' Experience in Two Centres

Abstract

The study objective was to evaluate the outcome of continuous arteriovenous hernofiltration (CAVH) as a first choice treatment for acute renal failure (ARF) in critically ill intensive care patients in two centres with a long experience in the field of continuous renal replacement therapies. Sixty consecutive intensive-care ARF patients from Uppsala Centre and 71 consecutive ARF patients from Vicenza Centre were included during a period of two years. Their age range was 58 f 16 and 52 f 15 years in Uppsala and Vicenza, respectively. CAVH was performed in the postdilution form using different types of hemofilters. Three choices of vascular access were utilised in each centre, namely: the Buselmeier shunt, femoral vessel catheter and the Scribner shunt. The pre-treatment serum urea level (mean Jt SD) in the Uppsala patients (30 f 14 mmol/l) was significantly higher (p<O.OOl) than that of the Vicenza patients (17 f 10 mmoV1). The Uppsala patients had a longer treatment duration than the Vicenza patients; 8 f 6 vs 5 f 5 days (p<0.05) perhaps because they were much older than the Vicenza patients (p<0.05) in addition to their multiorgan failure. However, the the total outcome of CAVH in the two centers was not significantly different (52 and 58% patient's survival in Uppsala and Vicenza, respectively). The results from this study between two centres with a relatively high activity in the treatment of ARF in critically ill patients confirm previous results from smaller patient series that CAW is an effective treatment in this type of patients if treatment starts early before the patient develops an advanced uremic state.