A comparison of continuous arteriovenous hemofiltration and intermittent hemodialysis in acute renal failure patients in the intensive care unit.

Our experience with high flow CAVH (1-2 L/hr) and intermittent hemodialysis in our combined medical-surgical tertiary care intensive care unit was reviewed. During a 16 month period, 12 patients received CAVH and 23 patients received hemodialysis (3-7 days/week). Mean CAVH treatment duration was 5.5 days (0.5-18 days). Hemodialysis patients received a mean of 4.3 treatments (1-16). CAVH patients had a mean age of 44.5 +/- 16.4 years (19-68), whereas the hemodialysis patients had a mean age of 60.9 +/- 14 years (34-82) (p = 0.004). Mean admission APACHE II score was 21.3 (11-29) for the CAVH group and 25.5 (10-39) for the hemodialysis group (p = NS). Peak ICU APACHE II score did not differ between groups (CAVH 26.2 [11-37], HD 28 [10-40]; p = NS). There were 4 deaths in the CAVH group (25%) and 19 deaths in the HD group (82%) (p = 0.006: chi-squared test). Although age was significantly different between groups, APACHE II scores were similar. Mortality rate was significantly higher in the hemodialysis group. This supports the hypothesis that CAVH may be the renal replacement therapy of choice in the ICU.