Continuous arteriovenous hemofiltration using small hollow-fiber hemofilters, without pumps, was used as an alternative to conventional methods of acute dialytic therapy. During a 6-month period, 15 patients had 17 treatments. Mean treatment duration was 98.5 +/- 101.1 (SD) hours (range, 4 to 300 hours), for a total of 1673 hours. Mean output per treatment was 9.5 +/- 4.4 mL/min, which was found to be adequate to control uremia despite a considerable protein intake. Six patients had a significant hemorrhage; however, all 6 had active bleeding and existing coagulopathies before beginning treatment. Overall, continuous arteriovenous hemofiltration was found to be a convenient and safe method for providing continuous fluid, electrolyte, and acid-base balance in patients with inadequate renal function. The treatment was particularly useful in patients with vascular instability or severe fluid overload.

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Quality of life is the most controversial issue surrounding home hemodialysis. We examined how sixteen adolescents and their six families reacted to having a father on home hemodialysis, exploring the interplay between adolescent developmental conflicts and family stresses. Family members underwent role changes to adjust to alterations imposed by hemodialysis. Some adolescents helped relieve family stresses by taking an active role in dialysis. These eight adolescents developed greater self-esteem which enhanced identity growth and facilitated separation. Psychological responses were observed that resembled the "death guilt," "psychic numbing," and "invisible contamination" described in Hiroshima survivors. Adolescent developmental problems can be dwarfed by family conflicts around chronic illness and dialysis. Families adjusted to home hemodialysis showing new growth, managing with a barely workable arrangement, or adapting unsuccessfully. Understanding more about how home hemodialysis can influence family interactions can enable the medical staff to facilitate beneficial changes, and thereby improve the quality of life for patient and family.