On-line Haemodiafiltration in the Management of Acute Renal Failure

Abstract

Purpose – Patients with acute renal failure (ARF) offer particular challenges in terms of cardiovascular stability during renal replacement therapy. Targets for small solute clearance are unclear, removal of inflammatory mediators is desirable, and biocompatible membranes are essential. This study examined the impact of using on-line haemodiafiltration (HDF), which combines convective and diffusive transport, with replacement fluid being produced “on-line” from reverse-osmosed water. Methods – Clinical outcomes were examined in all patients presenting with ARF. Initially, management of ARF included daily haemodialysis (4 hours with biocompatible membrane). Subsequently, all patients were managed with on-line HDF using the Gambro AK200 Ultra™, daily for 4 hours. In the initial stages of patient management, CVVH was used in the ICU setting throughout the study period. Pre 1 Pre 2 Post 1 Post 2 Alive (total) 4 9 18 29* Dead 10 5 9 11* Alive on chronic HD 5 8 11 3* Results – A comparison was made between the years prior to (Pre-1 and 2) and following (Post-1 and 2) the change to on-line HDF. (* p < 0.001 vs Pre 1/Pre 2). Conclusions – On-line HDF is a modality that combines cardiovascular stability and significant middle molecule clearance. Using on-line HDF in the management of ARF, there were significant improvements in survival and recovery of renal function.