Continuous arteriovenous haemofiltration. A new kidney replacement therapy

Abstract

Twenty intensive care patients, who as an additional complication developed acute oliguric renal failure were treated solely with continuous arteriovenous haemofiltration (CAVH). The mean spontaneous filtration rate was 8.8 +/- 3.5ml/min. IV substitution of the ultrafiltrate by K+-free Ringer's lactate solution resulted in a steady state plasma creatinine level of 6.4 +/- 3.5mg/dl. Duration of treatment was three to 24 days (10.5 +/- 7.9 days). Eight patients recovered kidney function and survived. Clinical experience in five intensive care units with more than 150 applications of CAVH allows the following conclusions: optimal control of water and electrolyte balance; unlimited parenteral nutrition; continuous fluid withdrawal better tolerated than intermittent withdrawal by means of dialysis. With skilled puncture of the femoral artery there was no risk of bleeding. Low dose continuous heparin administration (10IU/kg/hr) into the arterial blood line is sufficient for extracorporeal anticoagulation. Haemofilters can be used for a long time (two to ten days). Specially trained dialysis personnel and investment costs for machines are not necessary.