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Clinical Experience |
Medical Clinical, UNESP, Botucatu, Sao Paulo, Brazil
Objective: At present, the approach to the dialytic management of
acute renal failure (ARF) is very heterogeneous. There is no consensus on the
best method of dialysis in ARF. We performed a prospective study to compare
the effect of continuous peritoneal dialysis (CPD) and daily hemodialysis
(HDD) on survival rates in these patients (pts). Methods: A total of
120 pts with ARF for necrosis tubular acute (NTA) were randomized in 2 groups
(G) according to dialytic treatment: G1=CPD (n=60) and G2=HDD
(n=60). G1 was treated with flexible catheter (Tenckhoff) and cycler
and prescribed Kt/V per session (24 hours, 7x week) was 0.65. G2 was
treated with the polymer membrane and prescribed Kt/V was 1.2 per session
(6x week). Metabolic and acid–basic controls were secondary end
points. Statistics tests: Student's t-test, Mann–Whitney,
Kruskal–Wallis, and Dunns method (p<0.05). Results:
G1 and G2 were similar respect to age (64.2±19.8 vs 62.5±21.2
years), gender (male: 72% vs 66%), main cause of ARF (sepse:42% vs 38%),
severity of ARF (ATN-ISS: 0.68±0.2 vs 0.66±0.22), APACHE II
(26.9±8.9 vs 24.1±8.2), predialysis blood urea nitrogen (BUN)
(116.4±33.6 vs 112.6±36.8 mg/dL), and creatinine
(5.85±1.9 vs 5.95±1.4 mg/dL), oligury (54.8% vs 58.6%),
mechanical ventilation (75% vs 68%), and hemodynamic unstable (61% vs 63%). In
G1, weekly delivered Kt/V was 3.59±0.61 and in G2 it was
4.76±0.65 (p<0.01). Two groups were similar in metabolic
and acid–basic control (after 4 session BUN <60 mg/dL: 46±18.7
vs 52±18.2 mg/dL, pH 7.41 vs 7.38, and bicarbonate 22.8±8.9 vs
22.2±7.1 mEq/L). G2 resulted in longer duration of therapy (5.5 vs 7.5
days, p=0.02). Despite of delivered different dialysis methods and
doses, rate of survival did not differ between the groups (58% in G1 vs 52% in
G2), and recovery of renal function was similar (28% vs 26%).
Conclusions: Our study suggests that high doses and continuous PD by
flexible catheter and cycler was an effective treatment in ARF. It provided
high solute removal, allowing appropriate metabolic and pH control, with rate
survival and recovery renal function similar to HDD. In summary, CPD can
therefore be considered an alternative to other forms of renal replacement
therapy in ARF.
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