PMID- 31562715
OWN - NLM
STAT- MEDLINE
DCOM- 20191004
LR  - 20220410
IS  - 0004-5772 (Print)
IS  - 0004-5772 (Linking)
VI  - 67
IP  - 8
DP  - 2019 Aug
TI  - Comparative Evaluation of Continuous Veno-venous Hemodiafiltration and Continuous 
      Arterio-Venous Hemodiafiltration in Patients of Hepatic Failure and / or 
      Hepatorenal Syndrome.
PG  - 39-42
AB  - OBJECTIVES: Continuous renal replacement therapies (CRRT) are the most favoured 
      form of renal replacement therapies (RRT) in patients of decompensated liver 
      cirrhosis and hepatorenal syndrome (HRS). The role of CRRT has been limited only 
      to acute kidney injury and HRS in prior studies. We therefore aimed to evaluate 
      the role of two different modes of CRRT- CVVHDF and CAVHDF in patients of hepatic 
      failure and / or hepatorenal syndrome in reducing hyperbilirubinemia, uremia and 
      fluid overload. METHODS: 30 critically ill patients of hepatic failure and /or 
      HRS were randomly divided into two groups of 15 cases each. Group A patients 
      received continuous veno-venous hemodiafiltration (CVVHDF), whereas group B 
      patients underwent continuous arterio-venous hemodiafiltration (CAVHDF). The 
      inclusion criteria were hepatic failure and / or hepatorenal syndrome (HRS) with 
      hyperbilirubinemia and fluid overload in hemodynamically unstable patients, who 
      were unfit for conventional hemodialysis. RESULTS: Despite hemodynamic fragility 
      of the subjects, both the procedures were effective in achieving biochemical and 
      clinical improvements. There was a significant fall in blood urea, serum 
      creatinine and serum bilirubin at the end of procedures. After mean 27.32 h of 
      CVVHDF and 27.02 h of CAVHDF, blood urea decreased to 39.54 +/- 28.6 mg/dl and 
      45.11 +/- 31.9 mg/dl in respective groups. Serum bilirubin decreased to 7.01 +/- 6.4 
      mg/dl and 3.21 +/- 1.99 mg/dl in group A and B. All the patients had gradual and 
      steady improvement in pH and bicarbonate concentration towards normal. Urea 
      clearance was 24.98 +/- 1.09 ml/min and 22.72 +/- 1.58 ml/min respectively in the two 
      groups, whereas bilirubin clearance was 27.77 +/- 1.38 ml/min and 28.74 +/- 0.3 
      ml/min in group A and B respectively. Ultrafiltration rate had mean value of 
      141.66 +/- 22.33 ml/h in group A and 134.26 +/- 38.71 ml/h in group B. Both the modes 
      of CRRT were well tolerated without any new episodes of hypotension secondary to 
      the procedures and requirement of inotropes didn't change significantly. 
      Symptomatic relief and improvement in clinical and biochemical parameters were 
      observed in all the cases. There were no significant differences between the 
      results of two groups. Complication rate was less and survival was 30%. 
      CONCLUSION: Continuous hemodiafiltration is probably the best available modality 
      of CRRT to treat hemodynamically unstable and critically ill patients of hepatic 
      failure and/ or hepatorenal syndrome and it should be advocated more frequently.
CI  - (c) Journal of the Association of Physicians of India 2011.
FAU - Nand, Nitya
AU  - Nand N
AD  - Senior Professor and Head , Corresponding Author.
FAU - Verma, Preeti
AU  - Verma P
AD  - Resident.
FAU - Jain, Deepak
AU  - Jain D
AD  - Associate Professor, Department of Medicine and Division of Nephrology, Pt. B.D. 
      Sharma University of Health Sciences, Rohtak, Haryana.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PL  - India
TA  - J Assoc Physicians India
JT  - The Journal of the Association of Physicians of India
JID - 7505585
SB  - IM
MH  - *Acute Kidney Injury
MH  - *Hemodiafiltration
MH  - *Hepatorenal Syndrome
MH  - Humans
MH  - *Liver Failure
MH  - Renal Dialysis
MH  - Renal Replacement Therapy
EDAT- 2019/09/29 06:00
MHDA- 2019/10/08 06:00
CRDT- 2019/09/29 06:00
PHST- 2019/09/29 06:00 [entrez]
PHST- 2019/09/29 06:00 [pubmed]
PHST- 2019/10/08 06:00 [medline]
PST - ppublish
SO  - J Assoc Physicians India. 2019 Aug;67(8):39-42.