Continuous arteriovenous haemodiafiltration: optimal therapy for acute renal failure in an intensive care setting?

We report the results of continuous arteriovenous haemodiafiltration (CAVHD) treatment in 12 critically ill intensive care patients with acute renal failure (eight males, four females ‐ mean age 60.9 years ‐ range 47 to 76) (APACHE II score 28.8, range 18–37). All patients were oligo‐anuric or had a rising creatinine ( 100 JμM/L per day). Vascular access was obtained by Scribner shunt or wide‐bore femoral arterial and venous cannulae. At the beginning of CAVHD therapy the mean plasma urea was 38 mM/L (SE 4.5, 95% confidence interval (CI) 25.1 to 75.6 mM/L) and the mean creatinine was 604 μM/L (SE 70, 95% CI 450–756 μM/L). After 72 hours of therapy, despite oligoanuria, urea concentration had fallen to a mean of 15.7 mM/L (SE 2.4, 95% CI 12.5–22.9 mM/L) and the creatinine concentration to 297 μM/L (SE 25, 95% CI 243–351 μM/L), respectively. The mean ultrafiltrate volume was 441 mL/hr (SE 33, 95%, range 50–1050 mL/hr). There were no complications related to the extracorporeal circuit, the filter, anticoagulant therapy, electrolyte status or changes in patients' haemodynamic state. Excellent biochemical control of azotaemia was uniformly achieved during CAVHD therapy. Five patients (41.6%) survived to be discharged from the Intensive Care Unit. CAVHD is a simple, safe and effective continuous renal replacement therapy. CAVHD offers technical advantages over alternative therapy while providing equivalent or better biochemical control of azotaemia and volume status in critically ill patients with acute renal failure.