In the last three decades, the mortality associated with acute renal failure (ARF) in the
ICU has remained unchanged at greater than 50%, despite improvements in dialysis technology.
The primary objective is to determine whether Continuous Veno-Venous Hemodiafiltration
(CVVHDF) using an ultrafiltration rate of 35 ml/hr/kg (high dose) leads to a greater
reduction in all-cause ICU mortality compared to standard CVVHDF using an ultrafiltration
rate of 20 ml/hr/kg.
Although the worldwide standard for renal replacement therapy is intermittent
hemodialysis(IHD), continuous renal replacement therapy (CRRT) has emerged as an alternative
form of renal replacement therapy in the critical care setting due to its advantages of slow
continuous fluid removal, steady acid-base correction, and hemodynamic stability.
There are no standard protocols for initiating or administering CRRT, and practice patterns
vary widely among institutions, with less than 25% of patients with ARF in the ICU receiving
this therapy in the United States.
Various CRRT modalities are available that use diffusion, convection, or a combination of
both to obtain adequate solute clearance. However, there is no consensus as to the optimal
dialysis modality, adequate dialysis dose, or optimal clearance modality (convection vs.
diffusion). Clinical trials are needed to determine the optimal method of administering
CRRT, with respect to modality, dose of dialysis, and time of initiation of therapy.
Although some studies suggest that a higher dose of dialysis improves survival, there have
been no prospective randomized studies comparing the effectiveness of diffusion and
convection, combined together, for solute clearance.
- Male or female > or equal to 19 yrs of age
- ARF defined by at least one of the following:
- Volume overload from inadequate urine output despite diuretic agents.
- Oliguria (urine output < 200 ml/12hrs) despite fluid resuscitation and diuretic
- Anuria (urine output < 50 ml/12 hrs).
- Acute azotemia (BUN > or equal to 80 mg/dl).
- Acute hyperkalemia not responsive to medication (K+ > or equal to 6.5mmol/L)
- An increase in serum creatinine of > 2.5 mg/dl from normal values or a sustained
rise in serum creatinine of > or equal to 1 mg/dl over baseline.
- Patients with end stage renal disease
- Patients who have had more than one previous dialysis session for acute or chronic
renal failure during the current hospitalization
- Patient weight greater than 125 kg
- Patient weight less than 50 kg
- Non-candidacy for continuous renal replacement therapy (CRRT)
- Patient/surrogate refusal