Is Continuous Hemodiafiltration (CHDF) Always Useful in Treating Severe Acute Pancreatitis?

DOI 1 Citations 21 References
  • Kitamura Nobuya
    Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital

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  • CHDFは意味があるか？
  • 急性膵炎の診療ガイドラインにおけるCHDFの位置づけ
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Abstract

A nationwide survey demonstrated that continuous hemodiafi ltration (CHDF) is the blood purifi cation (BP) therapy most frequently performed in severe acute pancreatitis (SAP) ,though it results in poor survival. It also showed that the indications for and modality of BP as well as the timing of its initiation varied. Accordingly, the actual therapeutic effects of CHDF in SAP cannot be evaluated from these fi ndings. To determine the real clinical effi cacy of CHDF, whether it is performed to improve complicating acute renal failure (renal indication) or to remove causative humoral mediators exacerbating clinical pancreatitis (non-renal indication) should be considered. Also, the effects of CHDF may depend on the material of the membrane fi lter matrix in the hemofi lter. Although the effectiveness of CHDF in preventing organ failure has been suggested in several studies, the reliability of the data was limited, and recommendations for use of CHDF for this purpose (non-renal indication;Recommendation C1) had to be determined based on a lower level of evidence. However, aggressive CHDF is recommended for SAP with unstable hemodynamics and unsuccessful diuresis despite suffi cient volume infusion (renal indication;Recommendation B) ,as supported by recent fi ndings that earlier initiation of BP is more effi cacious in treating acute renal failure.

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