A PROSPECTIVE-STUDY OF CONTINUOUS HEMODIAFILTRATION IN THE MANAGEMENT OF SEVERE ACUTE-RENAL-FAILURE IN CRITICALLY ILL SURGICAL PATIENTS

被引：7

作者：

BELLOMO, R

FARMER, M

BOYCE, N

机构：

[1] Intensive Care Unit, Melbourne, VIC

[2] Department of Medicine, Monash Medical Centre, Clayton, Melbourne, VIC

来源：

RENAL FAILURE | 1994年 / 16卷 / 06期

关键词：

D O I：

10.3109/08860229409044905

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

Severe acute renal failure associated with surgical disease and a highly catabolic state poses a major therapeutic challenge. Treatment by conventional dialysis or arteriovenous hemofiltration suffers from serious shortcomings. The current study assesses the clinical and biochemical impact of a newer approach (continuous hemodiafiltration) in a cohort of 60 critically ill surgical patients with severe renal failure. All patients were studied pp ospectively and assessed for illness severity. Their biochemical response to therapy was analyzed and their clinical course to either death or hospital discharge documented. The use of continuous hemodiafiltration (CHD) permitted full control of azotemia in all patients (mean steady-state urea concentration: 19.8 mmol/L) and was associated with rapid control of acidemia (mean pretreatment pH: 7.27; mean ph after 24-h treatment: 7.35; p <. 001). During the 15, 696 h of therapy, there were no treatment-induced episodes of hypotension and/or hypoxemia. All patients were able to receive full-dose enteral (9) or parenteral (51) nutritional support with 1.5 to 2.5 g/kg/day of protein as tolerated. Despite their illness severity (mean APACHE II score: 28.9) and the need for vasopressor support and ventilation in 90% of cases, 21 patients (35%) survived to hospital discharge. We conclude that continuous hemodiafiltration is safe and effective in surgical critically ill patients with acute renal failure, and that it is associated with a low morbidity and an encouraging survival rate.

引用

页码：759 / 766

页数：8

共 28 条

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