Experience with continuous venovenous hemofiltration (CVVH) in the ICU: a report from a single center

During the last 7 years in our ICU, CVVH was used as renal support in 101 critically adults (79 M, 22 F, median age 57, range 17–86) with acute renal failure (ARF). Patients who were treated with CVVH for less than 24 hours were excluded from this report.

APACHE score at admission was 23 (median, range 8–42). The majority of the patients was on mechanical ventilation (98%) and needed vasopressor support (91%). Vascular access was performed with the use of a blood pump. Conventional heparin was used for anticoagulation in the most of the cases (90%).

In 31 of the patients (group A) CVVH was initiated upon their first day of admission while in the rest 70 pts (group B) CVVH was started on the 9th day, median (range 2–32) of their hospitalization in the ICU. Uremia was satisfactory controlled in most of the cases with a mean amount of ultrafiltrate of 38.7 ± 0.6 SEM, l/day (range 27–49.5). Patients of group A remained on CVVH treatment for a median of 5 days (range 1–40), while those of group B for 4.5 days (range 1–29), P = NS. Although serum creatinine levels at the initiation of CVVH did not show any difference between the groups (group A 4.9 ± 0.4 SEM, group B 5.2 ± 0.5 SEM, P = NS), the corresponding BUN level were lower in patients of group A (86.0 ± 7.1 SEM vs 112.8 ± 6.9 SEM, P = 0.021). The duration of hospitalization (days) in the ICU was also lower in the group A patients (10.7 ± 2.2 SEM vs 24.2 ± 2.0 SEM, P = 0.0001). Ten (10) patients of group A (32.2%) and 15 pts of group B (21.4%) were survived and discharged from the ICU, χ² = NS, with a mean serum creatinine and BUN levels that did not differ between these two groups. The overall mortality was 75.2%.

It is concluded that in the ICU the mortality rate of critically ill adults patients with ARF demanding renal support treatment remains high despite the use of CVVH and that the timing of ARF occurrence and CVVH initiation does not exert any major influence on the outcome of these patients.