Daytime Intermittent Venovenous Hemofiltration(IVVH) for the Treatment of Refrctory Edema / 대한신장학회잡지

BACKGROUND: Refractory edema in some patients with advanced heart failure or renal failure will not respond to diuretic therapy. In this setting, the ex- cess fluid can be removed by continuous hemofiltration either by continuous arteriovenous hemofiltration (CAVH) or continuous venovenous hemofiltration (CVVH). Careful monitoring is required to prevent life-threatening hypotension due to continued production of large ultrafiltrate. To overcome these disadvantages of CVVH, we attempted to perform daytime 1VVH as an alternative therapeutic modality to CVVH. METHODS: We performed venovenous hemofiltration for eight hours in the daytime in dialysis unit and repeated intermittently at 1 or 2 days interval if further treatment is required. We called this intermittent venovenous hemofiltration(IVVH). From October 1992 through November 1997, we prospectively studied the efficacy and usefulness of IVVH in 42 patients with refractory edema. RESULTS: Underlying disorders which required IVVH were renal insufficiency in 28 patients and nephrotic syndrome in 14 patients. The mean duration of treatment was 17.0+/-8.4 hours. Total UFR was 26.1+/-153L and mean UFR/hr was 1.5+/-2.2L. Edema was successfully controled with only one time treatment of IVVH in 12(28.6%), two in 17(40.5%), three in 7(16.6%), four in 4(9.5%), and five in 2(4.8%), Mean number of IVVH treatments per patient was 2.2+/-0.4 to complete the treatment of refractory edema. Changes in blood chemistry and hemodynamics before and after IVVH were not significantly different. Body weight and abdominal girth decreased significantly after IVVH(p<0.001). No major complications occurred during these trials. There were only two episodes(5.1%) of transient hypotension, and each one episode(2.6%) of bleeding at access site and arrhythmia, respectively. CONCLUSION: These results stongly suggest that IVVH is a simple, safe and effective method in the treatment of refractory edema not responding to diuretic therapy.

Nonrenal Indications for Continuous Arteriovenous Hemofiltration / 대한신장학회잡지

Continuous arteriovenous hemofiltration(CAVH) is used to treat hemodynamically unstable patients with renal failure, refractory ascites and edema, sepsis, or ARDS patients. Patients received CAVH during a 3-year-period from March 1994 to February 1997. Their clinical findings were analyzed retrospectively, and the results were as follows; They were 6 men and 3 women from 28 to 62 years. 3 patients had ARDS, 2 patients had CHF. The remainder had SLE, liver cirrhosis, septic shock with cholangitis, diabetic ketoacidosis with pulmonary edema. The duration of treatment ranged from 30 to 50 hours, with a mean of 41.6+/-6.9 hours. The total fluid repalcement was 22.4+/-1.7L and the mean fluid loss was 3.9+/-2.6L. Changes in serum BUN, creatinine, sodium, potasium before and after treatment were not significantly diffrent. The complication of CAVH is clotting of hemofilter, hypotension, bleeding, and mild thrombocytopenia. 2 of 3 ARDS patients expired during CAVH, liver cirrhosis patient expired later due to hepatic encephalopathy, and, finally 6 patients discharged with improved conditions. In conclusion, CAVH, a safe and effective therapy in hemodynamically unstable patients with renal failure, refractory ascites and edema, sepsis, or ARDS patients.

A Combined Therapy for Hyperphosphatemia in the Tumor Lysis Syndrome: Hemodialysis and Continuo Arteriovenous Hemofiltration / 대한신장학회잡지

The acute tumor lysis syndrome is an acute illness caused by massive cell lysis after chemotherapies. This syndrome is characterized by hyperuricemia, hyperphosphatemia with hypocalcemia and hyperkalemia. Among these electrolyte abnormalities, the most serious complication is the severe hyperphosphatemia (greater than 14mg/dL) that could result in sudden cardiac arrest or respiratory failure. In order to correct the severe hyperphosphatemia, hemodialysis has been used commonly as the renal replacement therapy . However the hemodialysis can make posthemodialysis serum phosphate rebounded unless the patient take this treatment for more than 6 hours. Therefore it is not sufficient to use hemodialysis treatment alone. To solve this problem, hemodialysis has been used with or replaced by the uninterrupted dialysis technique such as CRRT (continuous renal replacement therapy). We report a 33-year-old man with Burkitt lymphoma who showed severe hyperphosphatemia (peak phosphate value was 18.6mg/dL) during the course of chemotherapy. used with 5 day CAVH (continuous arteriovenous hemofiltration) his phosphate level could be maintained without any rebound. Therefore we concluded that CAVH in conjunction with hemodialysis would be a successful way to control severe hyperphosphatemia associated with tumor lysis syndrome.