Peritoneal Dialysis International, Vol. 31, pp. 422-429 doi: 10.3747/pdi.2009.00231 0896-8608/11 $3.00 + .00 Copyright © 2011 International Society for Peritoneal Dialysis 422 COMPARING CONTINUOUS VENOVENOUS HEMODIAFILTRATION AND PERITONEAL DIALYSIS IN CRITICALLY ILL PATIENTS WITH ACUTE KIDNEY INJURY: A PILOT STUDY Jacob George, Sandeep Varma, Sajeev Kumar, Jose Thomas, Sreepa Gopi, and Ramdas Pisharody Department of Nephrology, Medical College Hospital, Thiruvananthapuram, India ♦ Background: There are few reports on the role of perito- neal dialysis in critically ill patients requiring continuous renal replacement therapies. ♦ Methods: Patients with acute kidney injury and multi- organ involvement were randomly allotted to continu- ous venovenous hemodiafiltration(CVVHDF, group A) or to continuous peritoneal dialysis (CPD, group B). Cause and severity of renal failure were assessed at the time of initiating dialysis. Primary outcome was the composite correction of uremia, acidosis, fluid overload, and hyperkalemia. Secondary outcomes were improvement of sensorium and hemodynamic instability, survival, and cost. ♦ Results: Groups A and B comprised 25 patients each with mean ages of 45.32 ± 17.53 and 48.44 ± 17.64 respectively. They received 21.68 ± 13.46 hours and 66.02 ± 69.77 hours of dialysis respectively (p = 0.01). Composite correction was achieved in 12 patients of group A (48%) and in 14 patients of group B (56%). Urea and creatinine clearances were significantly higher in group A (21.72 ± 10.41 mL/min and 9.36 ± 4.93 mL/min respectively vs. 22.13 ± 9.61 mL/min and 10.5 ± 6.07 mL/min, p < 0.001). Acidosis was present in 21 patients of group A (84%) and in 16 of group B (64%); correction was better in group B (p < 0.001). Correction of fluid overload was faster and the amount of ultrafiltrate was significantly higher in group A (20.31 ± 21.86 L vs. 5.31 ± 5.75 L, p < 0.001). No significant differences were seen in correction of hyperkalemia, altered sensorium, or hemodynamic disturbance. Mortality was 84% in group A and 72% in group B. Factors that influenced outcome were the APACHE (Acute Physiology and Chronic Health Evalua- tion) II score (p = 0.02) and need for ventilatory support (p < 0.01). Cost of disposables was higher in group A than in group B [INR 7184 ± 1436 vs. INR 3009 ± 1643, p < 0.001 (US$1 = INR 47)]. ♦ Conclusions: Based on this pilot study, CPD may be a cost- conscious alternative to CVVHDF; differences in metabolic and clinical outcomes are minimal. Perit Dial Int 2011; 31(4):422-429 www.PDIConnect.com epub ahead of print: 28 Feb 2011 doi:10.3747/pdi.2009.00231 KEY WORDS: Acute kidney injury; continuous veno- venous hemodiafiltration; critically ill patients. C onventional hemodialysis is challenging in critically ill patients because of their hemodynamic instabil- ity, with multi-organ failure requiring inotropic and ventilatory support. Assuming lesser hemodynamic disturbances, continuous renal replacement therapies— especially continuous venovenous hemodiafiltration (CVVHDF)—have been tried in such patients (1). Continu- ous peritoneal dialysis (PD) has the advantages of ease of administration, minimal hemodynamic alterations, and safety in individuals with bleeding tendency and heparin allergy. Its use has been declining in developed countries, probably because of concerns about lower ef- ficacy (2,3), although the technique has been shown to be effective even in hypercatabolic states (4–7). In the resource-poor setting of developing coun- tries, continuous PD remains an important modality of renal replacement therapy because of its lower cost and ease of administration (2,8,9). We attempted an open prospective randomized comparative study of CVVHDF and continuous PD in critically ill patients, aiming for a sample size of 192. Over 3 years, we were able to recruit only 50 patients, which led us to stop the open study and to report our results as a pilot study. METHODS An open prospective randomized study of patients with acute kidney injury (AKI) and multi-organ involve- ment admitted to the intensive care unit and requiring renal replacement therapy (RRT) during a 3-year period starting in June 2005 was performed at Medical College Hospital, Thiruvananthapuram, South India, with prior approval from the institutional human ethical committee. We defined AKI as a rise in serum creatinine of 0.3 mg/dL Correspondence to: J. George, Nephrology, Medical College Hospital, Thiruvananthapuram, Kerala, India. drjacobgeo@rediffmail.com Received 28 October 2010; accepted 5 November 2010 This single copy is for your personal, non-commercial use only. For permission to reprint multiple copies or to order presentation-ready copies for distribution, contact Multimed Inc. at marketing@multi-med.com by guest on May 2, 2016 http://www.pdiconnect.com/ Downloaded from