Impact of Continuous venovenous hemofiltration/hemodiafiltration(CVVH/HD) on Survival in ARF Patients with Moderate Illness Severity and Borderline Hemodynamic Stability.

초록

Prognosis of critically ill patient with ARF is still poor with a high mortality. Since CVVH/HD tends to be reserved for ARF patients with more severe illness and unstable hemodynamic state, it is difficult to evaluate impact of dialysis modalities, CVVH/HD vs. IHD, on the survival of ARF. For adequate comparison of outcome and identification of candidate for each dialysis modality, we retrospectively analyzed the outcomes of each renal replacement method according to the illness severity and hemodynamic state at initiation of dialysis in all critically ill ARF admitted to medical ICU and required dialysis in 1996-1999 at our hospital (n=63). Illness severity was divided to 3 groups based on Cleveland Clinic Foundation (CCF) score; mild 1-7, moderate 8-14, severe 15-20. Hemodynamic state was divided to 3 groups according to systolic blood pressure immediately before dialysis; stable>125mmHg, borderline 105-124mmHg, unstable <104mmHg. Survivals of mild(29.1%), moderate(46.8%) and severe illness group(24.2%) were 94.4%, 37.9% and 0% and those of stable(32.3%), borderline(41.9%) and unstable(25.8%) hemodynamic group were 70.0%, 42.3% and 18.8%. Overall survival of our patients was 45.2% and 41.9% of total patients received CVVH/HD. Their survival was significantly low compared to those who received IHD by the log rank test (38.5% vs. 50.0%, P<0.007). CVVH/HD was underwent in only 11.1% of mild illness group that shows high overall survival and 46.7% of severe illness group in which none was survived. In moderate illness group, 58.6% of patients received CVVH/HD and their survival was significantly high survival compared to IHD (47.1% vs. 25.0%, P<0.0034). Hemodynamic state was a main factor in determining dialysis modality in our patients. All patient in stable hemodynamic group received IHD with a survival of 70%. All patient in unstable hemodynamic group patients received CVVH/HD with a survival of 18.8%. In borderline hemodynamic group, 38.5% of patients received CV