Continuous haemofiltration and haemodiafiltration for acute renal failure in severely burned patients.

Among 970 burned patients admitted between April 1987 and September 1994, 16 (1.6 per cent) presented acute renal failure requiring dialytic support and were treated by continuous renal replacement therapy as first-line modality. Their mean burned surface area was 58.0 +/- 5.7 per cent. Acute renal failure mainly occurred in the second week following admission in relation to sepsis and nephrotoxic drugs. Four types of continuous renal replacement therapy were performed: continuous arteriovenous haemofiltration and haemodiafiltration (CAVH and CAVHDF) and continuous venovenous haemofiltration and haemodiafiltration (CVVH and CVVHDF). Compared to 33 critically ill patients without burns also treated for acute renal failure by continuous haemofiltration or haemodiafiltration during the same period, the mean duration of therapy was longer for the burned patients (24.2 +/- 9.4 vs. 5.3 +/- 0.8 days). Although mean urine outputs and ultrafiltration rates were similar for both groups, fluid administration was higher for burned patients (8.2 +/- 0.7 vs. 3.3 +/- 0.2 l/day). Total weight loss during therapy was significantly greater in burned patients (12.6 +/- 3.6 vs. 6.8 +/- 1.0 kg), in relation to longer treatment period. Bleeding complications were more frequent in burned patients (56 vs. 15 per cent). Mortality rates were similar in both groups (82 vs. 82 per cent). In conclusion, when aggressive initial fluid resuscitation is applied following burn injury, the occurrence of acute renal failure is low, delayed and multifactorial. Since they are haemodynamically well tolerated and provide a good metabolic and volaemic control, continuous renal replacement therapies appear to be useful modalities for burned patients with acute renal failure. However, as bleeding complications are more frequent, careful monitoring is necessary.