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Comparison of Sustained Hemodiafiltration with Acetate-Free Dialysate and Continuous Venovenous Hemodiafiltration for the Treatment of Critically Ill Patients with Acute Kidney Injury

By Masanori Abe, Noriaki Maruyama, Shiro Matsumoto, Kazuyoshi Okada, Takayuki Fujita, Koichi Matsumoto and Masayoshi Soma


We conducted a prospective, randomized study to compare conventional continuous venovenous hemodiafiltration (CVVHDF) with sustained hemodiafiltration (SHDF) using an acetate-free dialysate. Fifty critically ill patients with acute kidney injury (AKI) who required renal replacement therapy were treated with either CVVHDF or SHDF. CVVDHF was performed using a conventional dialysate with an effluent rate of 25 mL·kg−1 · h−1, and SHDF was performed using an acetate-free dialysate with a flow rate of 300−500 mL/min. The primary study outcome, 30 d survival rate was 76.0% in the CVVHDF arm and 88.0% in the SHDF arm (NS). Both the number of patients who showed renal recovery (40.0% and 68.0%, CVVHDF and SHDF, resp.; P < .05), and the hospital stay length (42.3 days and 33.7 days, CVVHDF and SHDF, resp.; P < .05), significantly differed between the two treatments. Although the total convective volumes did not significantly differ, the dialysate flow rate was higher and mean duration of daily treatment was shorter in the SHDF treatment arm. Our results suggest that compared with conventional CVVHDF, more intensive renal support in the form of post-dilution SHDF with acetate-free dialysate may accelerate renal recovery in critically ill patients with AKI

Topics: Clinical Study
Publisher: SAGE-Hindawi Access to Research
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Provided by: PubMed Central

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  1. (2008). A .J .T o l w a n i ,R .C .C a m p b e l l ,B .S .S t o f a n
  2. Acetate intolerance is mediated by enhanced synthesis of nitric oxide by endothelial cells,”
  3. (1989). Acetate-free biofiltration: a viable alternative to bicarbonate dialysis,”
  4. (1988). Acute cardiovascularandmetaboliceffects ofacetate inmen,” Alcoholism:
  5. (2005). Acute renal failure in critically ill patients: a multinational, multicenter study,”
  6. (1996). Acute renal failure in intensive care units: causes, outcome, and prognostic factors of hospital mortality: a prospective, multicenter study.
  7. (1996). Acute renal failure,”
  8. (1996). Acute renal failure: a dangerous condition,”
  9. (1999). Continuous renal replacement therapyintheintensivecareunit,”IntensiveCareMedicine,vol.
  10. (2002). Developinga consensusclassificationsystem foracute renal failure,”
  11. (2000). Dialysate made from dry chemicals using citric acid increases dialysis dose,”
  12. (1998). Effect of acetate, bicarbonate dialysis, and acetate-free biofiltration on nitric oxide synthesis: implications for dialysis hypotension,”
  13. (1985). II: a severity of disease classification system,”
  14. (1978). Less dialysis-induced morbidity and vascular instability with bicarbonate in dialysate,”
  15. (2002). M .L a n g ,a n dR .F i s c h e r ,“ D a i l yh e m o d i a l y s i sa n d the outcome of acute renal failure,” New England
  16. (2009). Metabolic and hemodynamic advantages of an acetate-free citrate dialysate in a uremic case of congenital methylmalonic acidemia,”
  17. (2008). More-intensive renal replacement therapy has no benefit in critically ill patients with acute kidney injury,” Nature ClinicalPractice Nephrology,vol.4,no.11,pp.596–597,
  18. (2000). o n c o ,R .B e l l o m o ,P .H o m e le ta l . ,“ E ffects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial,”
  19. (2009). Revised equations for estimated GFR from serum creatinine in
  20. (2010). Suzuki et al.,“Comparisonof sustained hemodiafiltration with continuous venovenous hemodiafiltration for the treatment of critically ill patients with acute kidney injury,”
  21. (1986). The role of intensive dialysis in acute renal failure,”
  22. (1996). V i n c e n t ,R .M o r e n o ,J .T a k a l ae ta l .
  23. (2008). Zhang,T .Z.O ’ C onnore tal. ,“ I nt e nsityof renal supportincriticallyillpatientswithacutekidneyinjury,”