Efficacy of hemodiafiltration on the outcome of renal and respiratory failure of leptospirosis

Introduction

A comparison between hemodiafiltration (HDF) and peritoneal dialysis (PD) was performed in patients with severe leptospirosis with acute renal failure and lung injury.

Methods

Fifteen consecutive patients (seven under HDF and eight under PD) were studied. All of them were oliguric and underwent mechanical ventilation. There were no statistically differences in the parameters before dialysis: age (44 ± 5 versus 48 ± 5), APACHEII (22 ± 1 versus 20 ± 2), blood urea (Ur; 160 ± 20 versus 212 ± 31 mg/dl), serum creatinine (Cr; 5.5 ± 0.8 versus 7.0 ± 1.1 mg/dl), acidosis (17.5 ± 0.6 versus 15.2 ± 1.1 mEq/l), bilirubin (25.6 ± 3 versus 19.5 ± 4 mg/dl) or pyruvic transaminase (149 ± 44 versus 81 ± 10 IU). The pO₂/FiO₂ was worse in HDF than in the PD group (109 ± 17 versus 198 ± 25; P < 0.02).

Results

There were statistically differences between HDF and PD after the treatment: PaO₂/FiO₂ (299 ± 55 versus 159 ± 19; P < 0.02), Cr (2.8 ± 0.4 versus 6.0 ± 0.9 mg/dl; P < 0.01) and Ur (87 ± 12 versus 169 ± 21 mg/dl; P < 0.01). There were no statistically differences in survival (two versus three), time of recovery the renal function (12 ± 5 versus 13 ± 5 days), under mechanical ventilation (24 ± 2 versus 17 days) and the beginning of diuresis (8 ± 3 versus 8 ± 5 days).

Conclusion

The patients under HDF had a better metabolic control and oxygenation than those under HD. However, further studies will needed to show an impact on survival.