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 prospectively 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.