Critical Care and Shock

Continuous venovenous hemodiafiltration, impedance cardiography and critical care nephrology: a case study of chronic myeloid leukemia-associated acute renal failure

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Chronic myeloid leukemia (CML) is a hematologic malignancy characterized by clonal myeloproliferation of cells in the myeloid line, expressing the BCR-ABL fusion gene responsible for the oncogenic effect of the CML. Although the leukemic cells are minimally invasive, renal dysfunction is a known complication of the disease. Acute renal failure (ARF) caused by leukemic infiltration is relatively rare and often responds well to chemotherapy. We described an 80-year old CML patient who developed anuric ARF and was treated in our critical care nephrology (CCN) with hydrocarbamide in combination with impedance cardiography (ICG)-guided continuous venovenous hemodiafiltration (CVVHDF). Urine output was resumed and renal function improved within 1 day and 1 week, respectively. The chemotherapy and CVVHDF appeared to be effective therapeutic paradigm, whereas the use of ICG may offer extra guarantee especially in hemodynamically unstable patients. CCN could play a leading role in managing a broader spectrum of diseases rather than the adjunctive one of renal replacement therapy.