Abstract
Purpose
Continuous haemodiafiltration (CHDF) is a technique enhancing the efficiency of solute clearance of continuous haemofiltration by infusing dialysis fluid through the haemofilter. It has been reported to control water and electrolyte balance continuously without haemodynamic instability in critically ill patients with renal failure. Therefore, we used CHDF during and after cardiopulmonary bypass (CPB) in two renal failure patients, and discuss its efficacy.
Clinical features
The first patient undergoing aortic valve replacement had dialysis-dependent renal failure. Chronic renal failure in the second patient undergoing mitral valve replacement and coronary revasculanzation was controlled preoperatively with diuretics. In both cases, CHDF was performed not only during CPB but also in the post-CPB period. Serum concentrations of potassium, urea and creatmine were well-controlled in spite of large amount of blood transfused in the post-CPB penod (1000 ml fresh blood and 400 ml fresh frozen plasma in the fist patient, and 1400 ml fresh blood in the second patient). There was no difficulty in haemostasis dunng the use of nafamostat mesilate as an anticoagulant to keep activated clotting time at about 150 sec for CHDF in the post-CPB period.
Conclusion
Our initial expenences of CHDF dunng and after CPB suggest that the technique provides excellent electrolyte, metabolite and fluid management for the cardiac patients with chronic renal failure. Combined with nafarnostat mesilate for anticoagulation, CHDF was simple and safe and did not increase the nsk of bleeding.
Résumé
Objectif
La technique de l’hémodiafittration continue (HDFC) permet d’améliorer la clairance du soluté d’hémofiltration continue en perfusant le liquide de dyalise à travers un hémofiltre. Cette technique pourrait contrôler l’équilibre hydroélectrolytique en continu sans provoquer d’instabilité hémodynamique chez les insuffisants rénaux graves. L’utilisation de l’HDFC chez deux insuffisants rénaux pendant et après la circulation extracorporelle (CEC) nous offre l’occasion d’en discuter l’efficacité.
Éléments cliniques
Le premier patient opéré pour un remplacement valvulaire aortique souffrait d’une insuffisance rénale nécessitant dyalise. L’insuffisance rénale chronique du deuxième patient soumis à un remplacement valvulaire mitral et à une chirurgie de revascularisation myocardique était contrôlée en préopératoire par des diurétiques. Dans les deux cas. nous avons utilisé l’HDFCnon seulement avant mais aussi après la CEC. Nous avons réussi à contrôler les concentrations sériques du potassium, de l’urée et de la créatinine malgré les grandes quantités de sang transfusées à la pénode post-CEC (l 000 ml de sang frais et 400 ml de plasma frais congelé pour le premier patient et l 400 ml de sang frais pour le second patient). L’hémostase s’est maintenue pendant l’anticoagulation au mésilate de nafamostat administré à la pénode post-CEC de façon à conserver sous HDFC un temps de coagulation à 150 s environ.
Conclusion
Nos essais initiaux avec l’HDFC suggèrent que cette technique procure un excellent contrôle hydroélectrolytique et métabolique chez le patient cardiaque atteint d’insuffisance rénale chronique. Associée au mésilate de nafamostat pour I anticoagulation. l’HDFC s’est avérée sécuritaire et n’a pas augmenté le nsque de saignement.
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Kubota, T., Miyata, A., Maeda, A. et al. Continuous haemodiafiltration during and after cardiopulmonary bypass in renal failure patients. Can J Anesth 44, 1182–1186 (1997). https://doi.org/10.1007/BF03013342
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DOI: https://doi.org/10.1007/BF03013342