Sustained low-efficiency dialysis versus continuous veno-venous hemofiltration for postsurgical acute renal failure
Journal
American Journal of Surgery
Journal Volume
199
Journal Issue
4
Pages
466-476
Date Issued
2010
Author(s)
Wang W.-J.
Hu F.-C.
Chen Y.-W.
Kuo C.-C.
Tsai P.-R.
Ko W.-J.
Abstract
Background: In postsurgical acute renal failure patients with moderate unstable hemodynamics or fluid overload, the choice of dialysis modality is difficult. This study was performed to compare the outcomes between the sustained low-efficiency dialysis (SLED) and continuous veno-venous hemofiltration (CVVH) in these patients. Methods: Sequential postsurgical acute renal failure patients undergoing acute dialysis with CVVH (2002-2003), or SLED (2004-2005) as a result of severe fluid overload or moderately unstable hemodynamics were analyzed. Multivariate analyses of comorbidity, disease severity before initiating dialysis, biochemical measurements, and hemodynamic parameters for 3 days after the first dialysis session were performed by fitting multiple logistic regression models to predict patient's 30-day after hospital discharge (AHD) mortality. Results: Among the 101 recruited patients, 38 received SLED and the rest received CVVH. The 30-day AHD mortality was 62.4%. The independent risk factors of 30-day AHD mortality included older age (P = .008), lower first postdialysis mean arterial pressure (MAP) (P = .021), higher first postdialysis blood urea nitrogen level (P = .009), and absence of a history of hypertension (P = .002). A further linear regression analysis found that dialysis using SLED was associated with higher first postdialysis MAP (P = .003). Conclusions: Among the postsurgical patients requiring acute dialysis with severe fluid overload or moderately unstable hemodynamics, the patients treated with SLED had a higher first postdialysis MAP than those treated with CVVH, which led to lower mortality. Further multicenter randomized clinical trials of larger sample size are needed to compare the effects of SLED and CVVH on the outcomes of postsurgical acute dialysis patients. ? 2010 Elsevier Inc. All rights reserved.
SDGs
Other Subjects
adrenalin; diuretic agent; dobutamine; dopamine; heparin; isoprenaline; milrinone; noradrenalin; acute kidney failure; adult; aging; anticoagulation; article; cohort analysis; comorbidity; continuous veno venous hemofiltration; controlled study; dialysis; disease severity; female; groups by age; hemodynamic parameters; hemofiltration; hospital discharge; human; hypertension; intermethod comparison; major clinical study; male; mean arterial pressure; mortality; outcome assessment; postoperative complication; prediction; priority journal; risk factor; sustained low efficiency dialysis; urea nitrogen blood level; Adult; Age Factors; Aged; Biological Markers; Blood Pressure; Blood Urea Nitrogen; Comorbidity; Female; Hemodynamics; Hemofiltration; Humans; Kaplan-Meiers Estimate; Kidney Failure, Acute; Linear Models; Logistic Models; Male; Middle Aged; Multivariate Analysis; Predictive Value of Tests; Renal Dialysis; Risk Assessment; Risk Factors; Severity of Illness Index; Surgical Procedures, Operative; Taiwan; Time Factors
Type
journal article