Long-Term Quality of Life and Hospital Mortality in Patients Treated with Intermittent or Continuous Hemodialysis for Acute Renal and Respiratory Failure

Abstract

Objective. To describe long-term quality of life, intensive care, and hospital mortality in patients with acute renal and respiratory failure treated with one of two methods of renal replacement therapy (RRT). Design. Cross-sectional survey of long-term survivors from a prospective observational study of two methods of RRT. Setting. A combined surgical and medical intensive care unit in a university hospital. Patients and participants. One hundred and twenty-six patients with acute renal and respiratory failure who required treatment with RRT and mechanical ventilation. Interventions. 1. RRT for acute renal failure was with either continuous hemodialysis with ultrafiltration using biocompatible membranes and prostacyclin and heparin anticoagulation (CHDF) or intermittent hemodialysis using cuprophane membranes and heparin anticoagulation (IHD); 2. Health-related quality of life in long-term survivors was assessed with the SF-36 (HRQL) questionnaire. Measurements and main results. 1. There was no difference in ICU mortality (73.5%[39/53] IHD vs. 71.8%[46/64] CHDF, P = NS) or hospital mortality (83%[44/53] IHD vs. 76.5% [49/64] CHDF, P = NS) between the two RRT treatment groups. By 1999, there were 16 surviving patients; 2. Twelve of these survivors completed SF-36 forms (10 CHDF vs. 2 IHD). The overall physical health summary score and scores for seven of the health domains were significantly reduced. The mental health summary score and the domain mental health score did not differ from the general population. Conclusions. 1. The method of RRT used in ICU patients with ARF had no influence on survival; 2. The long-term survivors of multi-organ failure have poor physical health.