• Patricia Faria Scherer, Ilson Jorge Iizuka, Adriano Luiz Ammirati, Marisa Petrucelli Doher, Thais Nemoto Matsui, Dos SantosBento Fortunato CardosoBFCNephrology Division, Hospital Israelita Albert Einstein, São Paulo, Brazil.Dialysis Center, Hospital Israelita Albert Einstein, São Paulo, Brazil., MonteJulio Cesar MartinsJCMNephrology Division, Hospital Israelita Albert Einstein, São Paulo, Brazil., Marcelo Costa Batista, Virgilio Gonçalves Pereira, Dos SantosOscar Fernando PavãoOFPNephrology Division, Hospital Israelita Albert Einstein, São Paulo, Brazil.Nephrology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil., and DurãoMarcelino de SouzaMShttps://orcid.org/0000-0003-1341-5697Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, Brazil.Nephrology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil.Kidney Transplant Unit, Ho.
• Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, Brazil.
• Int J Artif Organs. 2021 Apr 1; 44 (4): 223-228.

Background/AimsContinuous renal replacement therapies (CRRT) are initially employed in patients with acute kidney injury (AKI) in ICU setting. After the period of serious illness, hemodialysis is usually used as a mode of transition from CRRT. Intermittent hemodiafiltration (HDF) is not commonly applied in this scenario.ObjectivesTo evaluate the feasibility of using HDF as transition therapy after CVVHDF in critically patients with AKI.MethodsAn observational and prospective pilot study was conducted in ICU patients with dialysis-requiring AKI. Patients were initially treated with CVVHDF and, after medical improvement, those who still needed renal replacement therapy were switched to HDF treatment.ResultsTen Patients underwent 53 HDF sessions (mean of 5.3 sessions/patient). The main cause of renal dysfunction was sepsis (N = 7; 70%). The APACHE II mean score was 27.6 ± 6.9. During HDF treatment, the urea reduction ratio was 64.5 ± 7.5%, for β-2 microglobulin serum levels the percentage of decrease was 42.0 ± 7.8%, and for Cystatin C was 36.2 ± 6.9%. Five episodes of arterial hypotension occurred (9.4% of sessions). There were 20 episodes of electrolytic disturbance (37.7% of sessions), mainly hypophosphatemia. No pyrogenic or suggestive episode of bacteremia was observed.ConclusionHemodiafiltration was safe and efficient to treat critically ill patients with acute kidney injury during the transition phase from continuous to intermittent dialysis modality. Special attention should be paid regarding the occurrence of electrolytic disturbance, mainly hypophosphatemia.

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