#3100 Adsorption membranes in continuous renal replacement therapy (CRRT) in acute renal failure associated with sepsis: preliminary clinical results

Abstract

Abstract Background and Aims Acute kidney INJURY (AKI) is a common complication (40%) in ICU patients, especially in septic patients, and it´s associated with high morbidity and mortality [2, 4]. Even though sepsis-associated AKI (S-AKI) is multifactorial, the elevation of cytokines plays a major role in its pathogenesis [3, 5]. This has promoted the use of adsorptive membranes in continuous renal replacement therapy (CRRT) in recent years. Method We performed a retrospective study in ICU patients with S-AKI who received CRRT with adsorptive membrane (Oxiris) from July 2021 to March 2023. We described clinical and analytical parameters at baseline, 24 and 48 hours after the start of therapy, and 30-day mortality. Results 11 patients (6 male) with mean baseline creatinine of 4.53 ± 2.76 mg/dl were included. The indications for starting CRRT were: renal support (n = 3; 28%) or as adjuvant therapy for sepsis at the discretion of the attending physician (n = 8; 72%) (Table 1). On admission, MAP was 72 ± 14.13 mmHg, serum lactate 2.7 ± 2.02 mmol/L. 7 patients (63%) required vasoactive drugs. The duration of therapy was 45 ± 18.46 h, with a prescribed effluent dose of 32 ± 4.14 ml/kg/h. There was a slight improvement in MAP at 24 and 48 hours (74 and 73.55 mmHg). A decrease in inflammation parameters (C-Reactive protein and procalcitonin) was evident at 24 (13.2% and 57%) and 48 (25% and 71%) hours of therapy without modification in the need of vasoactive drugs. Interestlying, lactate at 24 hours increased to 3.40 ± 3.80 and at 48 hours to 3.68 ± 6.30. Five patients died at day 30 (45%). Of the remaining six; four had a decrease in eGFR greater than 40% compared to baseline and 1 had a decrease of less than 40%. The last one continued maintenance hemodialysis. Conclusion Adsorptive membranes on top of standard of care (fluids resuscitation, broad-spectrum antibiotics and vasoactive drugs) in the first hours of S-AKI reduces the inflammatory response even though it does not change the need for vasoactive drugs. In our small cohort, mortality at 30 days and the decrease in eGFR greater than 40% from baseline were high, although similar to that described in the literature.