Intermittent Hemodialysis Low Intensity vs. on Line Hemodiafiltration in Critically Ill Patients with Sepsis and Acute Kidney Injury. Choosing the Best Treatment in a Developing Country

Abstract

Introduction: Acute kidney injury is a serious condition in critically ill patients with sepsis, in Ecuador the prevalence is about of 10% and has high undocumented mortality rate. The type of renal replacement therapy used is also very discussed in countries that have several treatment options. Many developing regions don’t have continuous treatments available for these patients. Objective: The aim of the study was to demonstrate advantages of treatment with on-line hemodiafiltration (own scheme) versus intermittent hemodialysis high flux low intensity in patients with sepsis and acute kidney injury. Primary outcomes evaluated were: mortality, vasoactive drugs, mechanical ventilation dependence and permanence at intensive care unit. Results: Cohort and tracing study in patients with sepsis and acute kidney injury. Two groups undergoing treatment for intermittent hemodialysis high flux low intensity (Group A: n 35) vs. on line hemodiafiltration (Group B: n 30). General mortality was 49.2%, (Group A: 60% vs. group B: 36.6% p=0.061). APACHE 2 and SOFA index in both groups were similar (p=0.26 and 0.98 respectively). Time intensive care unit stay (GA: 16.7; GB: 9.9 p=0.044), vasoactive drugs dependence (GA: 9; GB: 4.1 p=0.084), mechanical ventilation dependence (GA: 11.2; GB: 6.5 p=0.12). Conclusion: On line hemodiafiltration showed benefits statiscally significative in intensive care unit stay, in relation to vasoactive drugs, mechanical ventilation dependence showed beneficies but weren´t significatives. The mortality wasn't statistically significative. Results showed advantages in on line hemodiafiltration with our own scheme in critically ill patients with sepsis.