[Continuous hemodialysis with low blood flow and low dialysate flow in the treatment of acute renal insufficiency].

Slow continuous hemodialysis (SCHD) was performed in 9 patients with oliguric acute renal failure and cardiovascular instability. The vascular access was a Scribner's shunt in 7 patients and a double lumen venous catheter with a BSM22 blood system in 2 patients. Three different dialyzers were tested. The mean urea clearance was 10.8 +/- 1.5 ml/min with the 0.2 m2 polysulfone hollow fiber dialyzer, 14.3 +/- 2.7 ml/min with the 0.5 m2 AN 69 S parallel plate dialyzer and 13.8 +/- 1.8 ml/min with the 0.6 m2 AN 69 hollow fiber dialyzer. The mean dialysate flow rate was 15.6 +/- 1.9 ml/min, 15.2 +/- 0.7 ml/min and 15.1 +/- 1.6 ml/min for the three dialyzers, respectively. A linear relationship was documented for blood urea clearance and dialysate flow rate indicating clearly that low blood flow from 60 to 100 ml per min was appropriate for optimal diffusive transfer. The technic required continuous heparin anticoagulation. Three patients died of causes not related to the SCHD technic. When used in critically ill patients, SCHD is a simple method, suitable for intensive care unit staff with no trained dialysis nurses and allows an adequate control of uremia, fluid removal, acid base homeostasis and parenteral nutrition.