Abstract
IntroductionWhether continuous venovenous hemofiltration (CVVHF) is superior to extended daily hemofiltration (EDHF) for the treatment of septic AKI is unknown. We compared the effect of CVVHF (greater than 72 hours) with EDHF (8 to 12 hours daily) on renal recovery and mortality in patients with severe sepsis or septic shock and concurrent acute kidney injury (AKI).MethodsA retrospective analysis of 145 septic AKI patients who underwent renal replacement therapy (RRT) between July 2009 and May 2013 was performed. These patients were treated by CVVHF or EDHF with the same polyacrylonitrile membrane and bicarbonate-based buffer. The primary outcomes measured were occurrence of renal recovery and all-cause mortality by 60 days.ResultsSixty-five and eighty patients were treated with CVVHF and EDHF, respectively. Patients in the CVVHF group had significantly higher recovery of renal function (50.77% of CVVHF group versus 32.50% in the EDHF group, P = 0.026). Median time to renal recovery was 17.26 days for CVVHF patients and 25.46 days for EDHF patients (P = 0.039). Sixty-day all-cause mortality was similar between CVVHF and EDHF groups (44.62%, and 46.25%, respectively; P = 0.844). 55.38% of patients on CVVHF and 28.75% on EDHF developed hypophosphatemia (P = 0.001). The other adverse events related to RRT did not differ between groups. On multivariate analysis, including physiologically clinical relevant variables, CVVHF therapy was significantly associated with recovery of renal function (HR 3.74; 95% CI 1.82 to 7.68; P < 0.001), but not with mortality (HR 0.69; 95% CI 0.34 to 1.41; P = 0.312).ConclusionsPatients undergoing CVVHF therapy had significantly improved renal recovery independent of clinically relevant variables. The patients with septic AKI had similar 60-day all-cause mortality rates, regardless of type of RRT.
Highlights
Whether continuous venovenous hemofiltration (CVVHF) is superior to extended daily hemofiltration (EDHF) for the treatment of septic acute kidney injury (AKI) is unknown
The study profile is shown in Figure 1: 583 patients undergoing bedside renal replacement therapy (RRT) were screened, 299 patients with AKI were included, 187 met criteria for septic AKI, and 145 met the inclusion criteria of CVVHF (n = 65) and EDHF treatment (n = 80)
When classified according to the risk injury failure loss end-stage renal failure (RIFLE) criteria, there was no difference in risk, injury, and failure between groups, indicating that the timing of RRT initiation has no distinction in patients on CVVHF and EDHF
Summary
Whether continuous venovenous hemofiltration (CVVHF) is superior to extended daily hemofiltration (EDHF) for the treatment of septic AKI is unknown. We compared the effect of CVVHF (greater than 72 hours) with EDHF (8 to 12 hours daily) on renal recovery and mortality in patients with severe sepsis or septic shock and concurrent acute kidney injury (AKI). Multiple clinical treatments, including volume resuscitation and vasoconstrictor therapy, are only marginally effective in improving renal function and reducing mortality [3]. Since the first description of continuous arteriovenous hemofiltration in 1977, continuous renal replacement therapy (CRRT) has gained widespread acceptance for the treatment of AKI in hemodynamically unstable patients [4]. As improved hemodynamics is associated with less renal ischemia, CRRT may hasten recovery of renal function, and even result in increased survival [5]. Whether continuous hemofiltration therapy leads to improved outcomes in septic patients with AKI remains unclear
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