Background: Extended daily diafiltration (EDDf) is a prolonged intermittent dialysis technique introduced as an alternative to continuous renal replacement therapy in critically ill patients. Although EDDf has the advantages of ease of use, low cost and patient tolerability, there is concern that the high blood and dialysate flow rates used with EDDf may precipitate haemodynamic instability.
Objective: To identify whether haemodynamic changes occur during the course of EDDf therapy in adult patients who are admitted to the intensive care unit with sepsis and require dialysis.
Design, setting and participants: A prospective observational study of patients fitting the inclusion criteria who were admitted to the ICU of the Gold Coast Hospital, Queensland, during the period 1 January 2002 to 31 December 2005.
Main outcome measures: Mean arterial pressure (MAP) and heart rate (HR) before, during and after EDDf treatment.
Results: 178 EDDf treatments were administered to 44 patients. Haemodynamic parameters remained stable during EDDf, despite median blood flow rates of 265 mL/min and dialysate flow rates of 300 mL/min: MAP was 81.2 mmHg before EDDf v 82.7 mmHg after EDDf (P = 0.13); HR was 100.4 beats/min before EDDf v 98.9 beats/ min after EDDf (P = 0.23). For treatments in which vasopressive support was required (n = 75), no increase in dose requirement was observed. Patient mortality at the time of hospital discharge (41%) was less than the rate predicted by APACHE III scores (52%).
Conclusion: EDDf did not significantly worsen haemodynamic stability in patients with sepsis during their treatment.