Intensive Care Medicine

, Volume 22, Issue 8, pp 742–746 | Cite as

A randomized cross-over comparison of the hemodynamic response to intermittent hemodialysis and continuous hemofiltration in ICU patients with acute renal failure

  • B. Misset
  • J. -F. Timsit
  • S. Chevret
  • B. Renaud
  • F. Tamion
  • J. Carlet
Original

Abstract

Objective

To compare the hemodynamic response of ICU patients with acute renal failure of a 24-h continuous arteriovenous hemofiltration (CAVH) and that of patients with a 4-h intermittent hemodialysis (HD).

Design

Cross-over randomized clinical trial. The two periods to be compared were a 24-h CAVH and the 24-h encompassing a 4-h HD. These two periods were separated by a 24-h wash-out period.

Setting

Ten bed medicosurgical ICU of a tertiary care center in Paris, France.

Patients

Inclusion criterion was the requirement of replacement therapy for acute renal failure in patients already submitted to mechanical ventilation.

Interventions

CAVH was performed with Ringers' lactate used for restitution and infused before the hemofilter. The ultrafiltrate output was maintained at around 15 ml/min. HD was performed with a bicarbonate-buffered dialysate.

Mean outcome measures

Mean arterial pressure (MAP), use of adrenergic drugs, and change in body weight during each period.

Results

Twenty-seven consecutive patients were included, 15 CAVH-HD and 12HD-CAVH. CAVH and HD allowed the same metabolic efficacy. No hemodynamic parameter (MAP, amount of adrenergic drugs, change in body weight) differed between the two methods.

Conclusions

CAVH is equivalent to HD in terms of MAP and the use of vasopressive drugs and fluids. Establishing the superiority of CAVH would require carefully controlled studies assessing either outcome or changes in tissue oxygenation.

Key words

Continuous arteriovenous hemofiltration Hemofiltration Hemodialysis Renal replacement therapy Hemodynamic Tolerance Acute renal failure Intensive care unit 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Kramer P, Kaufhold G, Grôhne HJ et al (1980) Management of anuric intensive care patients with arteriovenous hemofiltration. Int J Artif Organs 3:225–230Google Scholar
  2. 2.
    Baldamus CA, Ernst W, Frei U et al (1982) Sympathetic and hemodynamic response to volume removal during different forms of renal replacement therapy. Nephron (Basel) 31:324Google Scholar
  3. 3.
    Hills M, Armitage P (1979) The two-period change-over design and its use in clinical trials. Br J Clin Pharmacol 8:7–20Google Scholar
  4. 4.
    Le Gall JR, Loirat P, Alperovitch A et al (1984) A simplified acute physiology score for ICU patients. Crit Care Med 12:975–977Google Scholar
  5. 5.
    Groeneveld ABJ (1990) Septic shock and multiple organ failure: treatment with hemofiltration? Intensive Care Med 16:489–490Google Scholar
  6. 6.
    Davenport A, Will E, Davidson AM (1993) Improved cardiovascular stability during continous modes of renal replacement therapy in critically ill patients with acute hepatic and renal failure. Crit Care Med 21:328–338Google Scholar
  7. 7.
    Myers ML, Austin TW, Sibbald WJ (1985) Pulmonary artery catheter infections. Ann Surg 201:237–241Google Scholar
  8. 8.
    Vincent JL (1991) European Society of Intensive Care Medicine. Expert Panel: the use of the pulmonary catheter. Intensive Care Med 17:I-VIIIGoogle Scholar
  9. 9.
    Kruse JA, Carlson RW (1987) Lactate metabolism. Crit Care Clin 3:725–746Google Scholar
  10. 10.
    Gutierrez G, Palizas F, Doglio G et al (1992) Gastric intramucosal pH as a therapeutic index of tissue oxygenation in critically ill patients. Lancet 339:195–199Google Scholar
  11. 11.
    Reinhart K, Hannemann L, Meier-Hellmann A et al (1994) Monitoring of oxygen transport and tissue oxygenation in septic shock. In: Reinhart K, Eyrich K, Sprung C (eds) Sepsis: current perspectives in pathophysiology and therapy. Springer, Berlin Heidelberg New York, pp 181–190Google Scholar
  12. 12.
    Bellomo R, McGrath B, Boyce N et al (1994) Effect of continuous venovenous hemofiltration with dialysis on hormone and catecholamine clearance in critically ill patients with acute renal failure. Crit Care Med 22:833–837Google Scholar

Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • B. Misset
    • 1
  • J. -F. Timsit
    • 1
  • S. Chevret
    • 2
  • B. Renaud
    • 1
  • F. Tamion
    • 1
  • J. Carlet
    • 1
  1. 1.Intensive Care UnitHôpital Saint-Joseph 7ParisFrance
  2. 2.Department of BiostatisticsHôpital Saint-Louis, 1ParisFrance

Personalised recommendations