INTERVENTION: MEASUREMENTS AND MAIN RESULTS: included the following: mean patient age was 60.9 years (range 21-81 yr); mean APACHE II score, 28.6 (95% confidence interval; 27.4-29.8); and number of failing organs, mean, 4.1 (95% confidence interval; 3.8-4.4). At commencement of
continuous venovenous hemofiltration with dialysis, 79% of patients were receiving inotropic drugs and 72% were septic, and, in 35%,
bacteremia or
fungemia was demonstrated.
Renal replacement therapy was applied for a mean duration of 186.2 hours (95% confidence interval; 149.2-223.7), with a mean hourly net ultrafiltrate production of 621 mL (95% confidence interval; 594-648) and a mean
urea clearance of 28.1 mL/min (95% confidence interval; 26.7-29.5).
Azotemia was controlled in all patients (plasma
urea < 30 mmol/L). During the more than 18,000 hours of treatment, there was no
therapy-associated hemodynamic instability. Complications were rare. They included two cases of hemofilter
rupture with minor blood loss and a single case of
bleeding at the site of the vascular-access
catheter. Forty-three patients survived to ICU discharge, and 40 survived to hospital discharge.
Continuous venovenous hemodiafiltration is a safe and an effective form of
renal replacement therapy in
critically ill patients. In such patients, who have a high predicted mortality rate, it was associated with a 40% survival rate. These findings suggests that
continuous venovenous hemodiafiltration may be ideally suited to patients with multisystem organ failure with
acute renal failure.