Safe and simple renal replacement therapy for hemodialysis patients with left ventricular dysfunction in the acute phase after cardiac surgery： Consideration of right heart parameters as preloading indices

Abstract

［Background］ Continuous hemodiafiltration (CHDF) has the advantage of achieving hemodynamic stability, but 24(cid:514)hour dialysis is associated with various problems, such as problems relating to patient restraint, medical staff education, personnel, and high medical costs. We investigated the effects of shortening the duration of dialysis from 24 hours to 8 hours by using CHDF. ［Method］ Twenty(cid:514)three patients with preoperative left ventricular ejection fractions of ＜55％ were divided into usual hemodiafiltration (group H) and 8 hoursʼ hemodiafiltration using CHDF (group L) groups. Using a right ventricular ejection catheter, we studied the changes in right heart parameters, such as right ventricular volume, that occurred during dialysis. ［Results］ Water removal relative to dry weight was larger, the rate of decline in right ventricular end(cid:514)diastolic volume was smaller, and the rate of reductions in blood pressure of ≥ 20％ was lower in group L. Creatinine and potassium levels were slightly higher, but within acceptable limits, in group L. ［Conclusions］ Performing 8 hours of CHDF(cid:514)based hemodiafiltration for 3 consecutive days after cardiac surgery enabled safe and sufficient removal of fluids and solution at the expense of dialysis efficiency. This technique may be employed as a simple and useful bridge to routine hemodialysis in medium(cid:514)sized hospitals like ours.