Hybrid renal replacement techniques vs continuous haemodiafiltration in haemodynamically unstable patients

Introduction

Acute renal failure in the critical care setting is a frequent and troublesome condition that can lead to significant morbidity and mortality. It is usually part of multiorgan failure with an expressive burden in the ICU.

Objectives

The authors present a retrospective study comparing a hybrid renal replacement technique (HRRT) vs a continuous renal replacement technique (CRRT) in two groups of haemodynamically unstable patients admitted to the medical/surgical ICU.

Materials and methods

One group (n = 26) received HRRT during 2003 and the other (n = 27) received CRRT during 2004, the year of implementation of HRRT in our ICU. Severity scores (SAPS II, APACHE II, SOFA and MODS), underlying disease and haemo-dynamic parameters were considered. Descriptive statistical analysis was performed by the mean and standard deviation for each parameter. Differences between numerical variables were analysed by Student's t test or using the Mann-Whitney test. Multiple regression analysis was performed to evaluated differences in mortality.

Results

Both groups of patients had similar severity scores, underlying diseases and haemodynamic profile (Table 1). The urea and creatinine reduction rates (UUR and CRR) were also evaluated. Patients treated with HRRT showed a lower mortality (62% vs 84%), less heparin need, and a higher URR and CRR. Odds for mortality in the CRRT group were about three times higher (95% CI, 0.86–12.11), but not statistically significant (P = 0.074) (Table 2).

Table 1

Table 2

Conclusion

HRRT is a valid alternative to CRRT in haemo-dynamically unstable critically ill patients. Further studies are needed to establish a difference in outcome related to the use of a particular renal replacement technique.