Ambalavanan S, Peterson J, Santos J
Limiting continuous venovenous hemofiltration in acute renal failure
Am Soc Nephrol
J Am Soc Nephrol (abstract) (Nov) 6:517 1995

Fifty-seven patients were treated with CVVH for multi-organ failure at Stanford. Survival was 10.5% (6/57) with 50% of these requiring chronic dialysis. This study suggests that CVVH may be futile if prolonged greater 6 days.

Comment: The high mortality in this study should be viewed in terms of the patient population that was studied: 56 patients were receiving multiple pressor drugs and 19 were receiving circulatory assist from an intraaortic balloon pump. Often CRRT procedures are used as a last resort in obviously futile patients and this should be recognized. (Mehta)

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Am Soc Nephrol
Other extracorporeal therapies : Continous therapies


Any therapy can be viewed as "futile" if the patient is desparately ill and recognizably "beyond-salvage" when that therapy is finally applied in an attempt to prolong life. We do not know if that was the case in the Stanford study. This is a very important question that must be adressed with prospective methods. Retrospective analyses of therapy with CVVH are now of little use and may be misrepresentative of the value and benefit of the modality when applied in the right setting. What that right setting is remains to be defined. Howver, data such as these are potentially misrepresentative. Studies are in progress looking at outcome with APACHE II scores and MSOF indexes. Stratification is critical to interpretation.
Rex L. Mahnensmith, MD (Rex.Mahnensmith@QM.yale.edu)
New Haven, CT USA-Wednesday, August 14, 1996 at 11:48:48 (CDT)