Continuous arteriovenous hemodiafiltration: an aggressive approach to the management of acute renal failure.

Continuous arteriovenous hemodiafiltration (CAVHD) offers a modified therapeutic approach to the patient with acute renal failure. The system employs a hollow-fiber dialyzer, whose perfusion is dependent on the patient's BP. Peritoneal dialysis solution is infused through the dialysate ports in a direction countercurrent to blood flow at a rate of 500 to 1,500 mL/h. Five complex patients with acute renal failure were treated with CAVHD for periods ranging from two to 40 days. Urea clearances approached 37 L/d, and in stable patients, the BUN was maintained at 40 to 60 mg/dL and serum creatinine 1.4 to 4.0 mg/dL. Ultrafiltration up to 1 L/h could be obtained without difficulty. CAVHD is a safe and technically simple procedure that is particularly suitable for hemodynamically unstable patients with ongoing needs for fluid removal.