Clinical aspects and applications of hemofiltration.

Thirty patients were referred for intermittent hemofiltration (HF) and were followed for long-term effects. Biochemical and uremic controls were comparable to those in the preceding hemodialysis (HD) period. All patients preferred to continue HF since they suffered fewer and less serious treatment-related complications. One hundred critically ill patients who developed acute renal failure were treated with continuous arteriovenous hemofiltration (CAVH). The survival rate was 45% and adequate uremic control was achieved with CAVH alone in 89 patients. The major improvement obtained with CAVH was the possibility of giving adequate nutritional support without the risk of overhydration, even to anuric hypotensive patients. The pharmacokinetics of intravenous cefuroxime was studied during HF and CAVH. During HF removal of cefuroxime was considerably higher than during HD. During CAVH, extrarenal clearance was two thirds of the total clearance. Dosage recommendations for HF and CAVH are given. Aluminum clearance and aluminum removal after a desferrioxamine infusion test was found to be 2.5-3 times higher during HF than during ordinary HD. A combination of HD and charcoal hemoperfusion was found to be more effective than HD, but less effective than HF. During HF there was a significant decrease in intact parathyroid hormone (PTH) in serum as well as in mid-C regional PTH and C-terminal PTH. Significant amounts of intact PTH were found in the ultrafiltrate of 8 of 17 patients. Another explanation of the fall in PTH was a down-regulation of the secretion of intact PTH, since there was an increase in serum calcium during hemofiltration. Osteocalcin--i.e., bone Gla-protein--was found in the ultrafiltrate during hemofiltration in all patients and the serum levels of osteocalcin decreased significantly during hemofiltration.