Korean J Nephrol.  2006 Mar;25(2):235-241.

Clinical Significance of Continuous Veno-Venous Hemodiafiltration as an Initial Renal Replacement Therapy for Acute Renal Failure after Cardiovascular Surgery

• Park EJ
• Kim SH
• Lee EK
• Chang JW
• Song H
• Song MG
• Yang WS
• Kim SB
• Park SK
• Lee SK
• Park JS

Abstract

BACKGOUND: Although continuous venovenous hemodiafiltration (CVVHDF) has many therapeutic advantages, previous studies did not report the improvement of survival rate by CVVHDF compared to that by hemodialysis (HD). It could be attributed to that they did not analyze the results under the appropriate stratification of severity and to multiorgan failure.
METHODS
We performed retrospective study to compare the outcomes of 88 patients with acute renal failure after major cardiovascular surgery(s). Among them, 48 patients (M:F=32:16, Age 58+/-11 years) were treated by CVVHDF and 40 patients (M:F=27:13, Age 59+/-10 years) were treated by HD. The severity of illness was estimated by APACHE III score system at the initiation of renal replacement therapy (RRT) and we also evaluated renal outcome and survival.
RESULTS
There was no significant difference between two groups in baseline characteristics, cause of surgery, survival rate and renal outcome. However, compared with those of HD group, CVVHDF group showed longer period of application with mechanical ventilator (p=0.001), longer period of vasopressor use (p<0.001), longer stay in intensive care unit (p=0.004) and higher APACHE III score at the initiation of renal replacement therapy (p=0.009). Among those with APACHE III scores over 90, survivors existed in CVVHDF group with the survival rate of 50%. In contrast, there was no one who survived in HD group (p=NS).
CONCLUSION
Although this study revealed that CVVHDF could be more useful than HD as an initial RRT for the patients with renal failure after major cardiovascular surgery, the randomized prospective study will be required to accept clinical usefulness of CVVHDF.

Keyword

Continuous venovenous hemodiafiltration (CVVHDF); Hemodialysis; Acute renal failure; Cardiovascular surgery

MeSH Terms

Acute Kidney Injury*
APACHE
Hemodiafiltration*
Humans
Intensive Care Units
Renal Dialysis
Renal Insufficiency
Renal Replacement Therapy*
Retrospective Studies
Survival Rate
Survivors
Ventilators, Mechanical