Veno–venous continuous renal replacement therapy for burned patients with acute renal failure

Abstract

From 1995 to 1998, 12 burned patients with acute renal failure (ARF) were treated by veno–venous continuous renal replacement therapy (CRRT) at the Burn Unit of Hôtel-Dieu de Montréal. Their mean (±SD) age was 51±12 years, and the mean burned surface covered 48.6±15.8% of total body surface area. All patients were mechanically ventilated and presented evidence of sepsis. The mean delay before occurrence of ARF was 15±6 days and ARF was mainly related to sepsis and hypotension. Main reasons for CRRT initiation were azotemia and fluid overload. A total of 15 CRRT modalities were applied (12 continuous veno–venous hemodiafiltration, CVVHDF; two continuous veno–venous hemofiltration, CVVH; and one continuous veno–venous hemodialysis, CVVHD) over 14±13 days. For CRRT, nine patients received heparin and three were not anticoagulated. Mean values for dialysate and reinjection flow rates were 1134±250 ml/h and 635±327 ml/h, respectively. Admission weight was 78.8±12.7 kg with a mean weight gain before CRRT initiation of 10.0±5.8 kg and a mean weight loss during CRRT of 8.9±5.5 kg. Nine patients received enteral plus parenteral nutrition, and three, parenteral nutrition only; the total caloric intake was 31.5±7.0 kcal/kg/day and protein intake, 1.8±0.4 g/kg/day. The normalized protein catabolic rate (nPCR) was evaluated at 2.28±0.78 g/kg/day during CRRT. The mortality rate was 50%. The six survivors all recovered normal renal function with four of them requiring intermittent hemodialysis for short periods. In conclusion, veno–venous CRRT is particularly well suited for this selected population allowing smooth fluid removal and aggressive nutritional support.