[Continuous blood purification therapy on 16 patients with diabetic ketoacidosis and acute kidney injury].

Objective: To determine the effectiveness of Continuous blood purification (CBP) therapy on diabetic ketoacidosis (DKA) and acute kidney injury (AKI) in diabetic nephropathy (DN) patients.

Methods: Sixteen DN patients who developed severe DKA and AKI between 2008 and 2011 in the West China Hospital were recruited. All of the recruited patients presented with severe metabolic acidosis, electrolyte disturbance and dehydration. In addition to routine treatments, continuous venovenous hemofiltration (CVVH) was performed for at least 48 h with Baxter Accura or B. Braun Diapact CRRT machine and B. Braun Diacap Acute M hemofilter. Hemofiltration was accomplished using predilution bicarbonate replacement fluid at the rate of 3000 mL/h and citrate or low-molecular weight heparin (LMWH) for anticoagulation, with blood flow rates of 180 to 250 mL/min.

Results: One patient died unexpectedly 10 h after admission to hospital. The other fifteen patients had significant improvements in metabolic acidosis index after 12 hours of CVVH therapy, such as an average increase of 7.21 +/- 0.07 carbon dioxide combining power (CO2CP)and improvement of arterial PH. The blood urea nitrogen (BUN), serum creatinine (SCr), serum glucose (Glu), serum potassium (K(+)) and bloodosmotic pressure of the 15 patients decreased significantly after 48 hours of CVVH therapy. Eleven cases entered into diuretic phase and had renal functions recovered (12 +/- 5) d and (18 +/- 12) d after admission to the hospital, respectively.

Conclusion: CVVH therapy as an early intervention can bring significant benefits to DN patients with DKA and AKI. Early institution of CVVH therapy may be considered not only for treating uremia and fluid retention but also for correcting metabolic abnormalities like metabolic acidosis.