Continuous Venovenous Hemofiltration Treatment Research Articles

Evaluation of plasma exchange and continuous veno-venous hemofiltration for the treatment of severe avian influenza A (H7N9): a cohort study.

Avian influenza A (H7N9) is a severe disease with high mortality. Hypercytokinemia is thought to play an important role in the pathogenesis. This study was to investigate the efficiency of plasma exchange (PE) + continuous veno-venous hemofiltration (CVVH) on the removal of inflammatory mediators and their benefits in the management of fluid overload and metabolic disturbance. In total, 40 H7N9-infected patients were admitted to our hospital. Sixteen critically ill H7N9-infected patients received combination of PE and CVVH. Data from these 16 patients were collected and analyzed. The effects of PE + CVVH on plasma cytokine/chemokine levels and clinical outcomes were examined. H7N9-infected patients had increased plasma levels compared to healthy controls. After 3 h of PE + CVVH treatment, the cytokine/chemokine levels descended remarkably to lower levels and were maintained thereafter. PE + CVVH also benefited the management of fluid, cardiovascular dysfunction and metabolic disturbance. Of the 16 critically ill patients who received PE + CVVH, 10 patients survived. PE + CVVH decreased the plasma cytokine/chemokine levels significantly. PE + CVVH were also beneficial to the management of severe avian influenza A (H7N9).

Continuous veno-venous hemofiltration to adjust fluid volume excess in septic shock patients reduces intra-abdominal pressure.

To analyze the effect and the time course of continuous veno-venous hemofiltration (CVVH) with net ultrafiltration (UF) on intra-abdominal pressure (IAP) body fluid volumes in septic shock patients with acute kidney injury (AKI). Patients were studied at baseline and after 6, 12, 24, 48, 72, and 96 hours of CVVH treatment. IAP was measured via the bladder, and abdominal perfusion pressure (APP) was calculated as mean arterial pressure minus IAP. Fluid volume excess (VE), total body water (TBW), extracellular body water (ECW), and intracellular body water (ICW) were derived from wholebody bioimpedance analysis (BIA). 30 patients entered final analysis, of which 6 died during CVVH (non-survivors). Fluid VE, TBW, ECW, ICW, and IAP significantly decreased in 24 survivors, whereas these variables remained essentially unchangedin non-survivors. APP slowly increased in survivors, while it did not change in nonsurvivors. IAP strongly correlated with VEin survivors: The lower the IAP, the lower the fluid volume excess. CVVH with net UF successfully reduced IAP, TBW, ECW, and ICW in critically ill patients who survived 96 h of CVVH. Failure to increase APP was associated with fatal outcome, and, finally, IAP correlated with fluid volume excess. BIA could be helpful to monitor fluid status in patients with AKI.

The hemodynamic effects during sustained low-efficiency dialysis versus continuous veno-venous hemofiltration for uremic patients with brain hemorrhage: a crossover study

Hemodynamic instability occurs frequently during dialysis treatment and remains a significant cause of patient morbidity and mortality, especially in patients with brain hemorrhage. This study aims to compare the effects of hemodynamic parameters and intracranial pressure (ICP) between sustained low-efficiency dialysis (SLED) and continuous veno-venous hemofiltration (CVVH) in dialysis patients with brain hemorrhage. End-stage renal disease (ESRD) patients with brain hemorrhage undergoing ICP monitoring were enrolled. Patients were randomized to receive CVVH or SLED on the 1st day and were changed to the other modality on the 2nd day. The ultrafiltration rate was set at between 1.0 kg/8 hrs and 1.5 kg/8 hrs according to the patient's fluid status. The primary study end point was the change in hemodynamics and ICP during the dialytic periods. The secondary end point was the difference between cardiovascular peptides and oxidative and inflammatory assays. Ten patients (6 women; mean age 59.9 ± 3.6 years) were analyzed. The stroke volume variation was higher with SLED than CVVH (generalized estimating equations method, p = 0.031). The ICP level increased after both SLED and CVVH (time effect, p = 0.003) without significant difference between modalities. The dialysis dose quantification after 8-hour dialysis was higher in SLED than CVVH (equivalent urea clearance by convection, 62.7 ± 4.4 vs 50.2 ± 3.9 ml/min; p = 0.002). Additionally, the endothelin-1 level increased after CVVH treatment (p = 0.019) but not SLED therapy. With this controlled crossover study, the authors provide the pilot evidence that both SLED and CVVH display identical acute hemodynamic effects and increased ICP after dialysis in brain hemorrhage patients. CLINICAL TRIAL REGISTRATION NO.: NCT01781585 (ClinicalTrials.gov).

Impact of Different Types of Resuscitation Fluids on Coagulation and Continuous Venovenous Hemofiltration Hemocompatibility in a Porcine Model

Intensive therapy demanding diseases (organ failure or sepsis) are assumed to be the etiology behind a decreased biocompatibility of extracorporeal systems for renal replacement therapy (RRT). There are also potential interactions between different components of the overall therapy. Volume substitutes are known to influence hemorheology and coagulation. To define a potential net effect of volume substitutes on the hemocompatibility of an RRT, we chose an animal model without interfering pathophysiologies. According to the problem of early filter failure and coagulation disorders in critically ill patients, we focused on the hypothesized interaction between RRT and different volume substitutes with respect to blood cell counts, coagulation parameters and required heparin dose. Forty-eight pigs were assigned to four groups of fluid therapy with either normal saline (NaCl), 6%HES130kD/0.4 (HES130), 6%HES200kD/0.5 (HES200) or 4%gelatin (GEL). Six pigs of each fluid group underwent continuous venovenous hemofiltration (CVVH), the remaining six served as the control group. Anticoagulation was performed with continuous heparin infusion. CVVH was run in a recirculation-mode for 4.5 h to force hemocompatibility reactions, thereafter in a standard-mode for 2 h. During the CVVH-treatment GEL reduced platelet counts and fibrinogen concentration and additionally lowered ATIII levels. Heparin requirements did not differ between different volume substitutes or CVVH and control groups. Severe pathophysiologies are not the only reason for a reduced hemocompatibility of CVVH treatment. Interaction of a particular volume substitute with CVVH should be considered when interpreting study results and evolving new strategies.

Coupled Plasma Filtration Adsorption Combined With Continuous Veno-venous Hemofiltration Treatment in Patients With Severe Acute Pancreatitis

Severe acute pancreatitis (SAP) still has a high mortality rate. Coupled plasma filtration adsorption (CPFA) and continuous veno-venous hemofiltration (CVVH) are 2 extracorporeal blood purification techniques. We hypothesized that CPFA combined with CVVH could preferentially improve prognosis and suppress clinical manifestations of SAP. In this observational cohort study, 25 patients with SAP were enrolled, in which 12 received CPFA plus CVVH treatment (group 1), and 13 received CVVH therapy (group 2). All the patients underwent a successive 10-day intervention. Clinical indicators were detected before or after the intervention and the results were compared between the 2 groups. The feasibility and the survival rate were evaluated on day 28. Compared with group 2, oxygenation index (PaO(2)/FiO(2)), mean arterial pressure, serum amylase, and blood urine nitrogen showed significant differences (all P<0.01) and serum TNF-α, IL-1β, IL-6 were reduced and IL-10 was elevated with time in group 1 (all P<0.01). Liver functions, electrolyte, and acid-base balance did not show significant difference before and after the 10-day treatment with CPFA plus CVVH compared with CVVH (P>0.05). No therapy-related adverse reactions were noted in both groups. Twenty-eight-day survival rate of group 1 was higher than that in group 2 [91.7% (11/12) vs. 53.8% (7/13), P<0.05]. CPFA combined with CVVH was an effective and safe method for treatment of SAP patients, the mechanism being related to its effect on regulating the level of cytokines and serum amylase.

Toll-like Receptor Kinetics in Septic Shock Patients: A Preliminary Study

The aim of this study is to evaluate some inflammatory parameter changes in septic shock patients and their possible correlation with clinical outcome, in particular when continuous veno-venous hemofiltration (CVVH) treatment is required. Considering the objective difficulty in enrolling this kind of patient, a preliminary study was initiated on seventeen septic shock patients admitted to a medical and surgical ICU. The mRNA expression of Toll-like receptor (TLR)-1, TLR-2, TLR-4, TLR-5, TLR-9, TNFα, IL-8 and IL-1β was assessed, the plasmatic concentrations of IL-18, IL-2, IL-10 and TNFα were measured on the day of sepsis diagnosis and after 72 h. In those patients who developed acute renal failure unresponsive to medical treatment and who underwent CVVH treatment the same parameters were measured every 24 h during CVVH and after completion of the treatment. On sepsis diagnosis, gene expression of TLRs was up-regulated compared to the housekeeping gene in all the patients. After 72 h, in 35% of the patients a down-regulation of these genes was found compared to day 1, but it was not associated with a reduction of cytokine serum levels or improved clinical signs, better outcome or reduced mortality. After high volume hemofiltration treatment, cytokine serum levels and TLR expression were not significantly modified. In conclusion, considering the not numerous number of cases, from our preliminary study, we cannot certainly correlate TLR over-expression in septic shock patients with severity or outcome scores.

Regional Citrate Anticoagulation Reduces Polymorphonuclear Cell Degranulation in Critically Ill Patients Treated With Continuous Venovenous Hemofiltration

Citrate which chelates ionized calcium can be used as regional anticoagulation in continuous venovenous hemofiltration (CVVH). This is the first study conducted to examine the potentially additive benefit effect of regional citrate anticoagulation (RCA) on polymorphonuclear (PMN) cell degranulation of myeloperoxidase (MPO) and cytokines production in patients with critically acute kidney injury (AKI) undergoing CVVH treatment. This prospective randomized controlled trial was conducted in 20 critically ill patients with AKI who underwent CVVH. The patients were randomized into regional citrate group (n=10) and heparin group (n=10). The pre-dilution CVVH with polyethersulfone dialyzers were utilized in both groups. The levels of pre-filter and post-filter MPO as well as inflammatory and anti-inflammatory cytokines were measured at baseline, 6h, and 24 h after initiating CVVH. In the heparin group, the post-filter serum MPO levels were significantly higher than the pre-filter (median 49.0 vs. 60.5 ng/mL, P<0.05) at 6 h. There were no significant differences between pre- and post-dialyzer MPO levels in the citrate group. Citrate could significantly decrease systemic pre-filter serum MPO levels from baseline at 6 h (median 43.5 vs. 17.3 ng/mL, P<0.01) as well as IL-8 levels (P<0.05) whereas heparin provided only significant TNF-α reduction (P<0.05). The CVVH circuit survival in the citrate group was longer than the heparin group. In conclusion, citrate, utilized as a regional anticoagulant in CVVH, can reduce both membrane bioincompatibility-induced and systemic oxidative stress and inflammation, and can prolong CVVH circuit survival time.

Therapeutic value of continuous veno-venous hemofiltration administration in treating fulminant myocarditis

ObjectiveTo evaluate the therapeutic effects of continuous veno-venous hemofiltration (CVVH) in treating fulminant myocarditis (FM).Methods and resultsWe retrospectively analysed 8 cases of FM patients in our institution from March 2009...

The impacts of continuous veno-venous hemofiltration on plasma cytokines and monocyte human leukocyte antigen-DR expression in septic patients

The aim of this study was to investigate the impacts of continuous veno-venous hemofiltration (CVVH) on plasma cytokines and monocyte human leukocyte antigen-DR (HLA-DR) expression and to evaluate the relationship between them during CVVH treatment in septic patients. Forty septic patients were enrolled in this study. They were randomly divided into control group (who received conventional treatment, n=20) and CVVH group (who received conventional treatment and CVVH treatment, n=20). The blood samples were taken to measure the changes of plasma cytokines (IFN-gamma, TNF-alpha, IL-1, IL-2, IL-4, IL-6, IL-10 and IL-13) and HLA-DR expression on monocytes. After CVVH treatment, the plasma levels of IFN-gamma, IL-1, IL-2, IL-4, IL-10 and IL-13 in septic patients were markedly decreased (P<0.05), while the levels of TNF-alpha and IL-6 were only lowered to some extent without significant difference (P>0.05). HLA-DR expression on monocytes improved in CVVH treated patients (P<0.05). No matter pre-treatment or post-treatment of CVVH, there was a negative correlation between plasma IL-10 and monocyte HLA-DR expression (P<0.05). In contrast, no obvious change was shown in control patients. Our findings suggest that CVVH is effective in removal of many plasma cytokines and in improvement of monocyte HLA-DR expression in septic patients.

Effect of continuous veno-venous hemofiltration in treatment of severe acute pancreatitis

Objective To explore the effect of continuous veno-venous hemofiltration(CVVH) on patients with severe acute panereatitis(SAP). Methods Twenty patients with severe acute pancreatitis were treated with CVVH. Their clinical data including cell gene mensuration、part of biochemistry index、APACHEⅡscore etc were analysed. Results All patients'temperature and abdominal distention、bellyache were evidently easely after the CVVH treat ment,TNF-α、IL-8 in blood were declined, K+ 、 Cr were also improved to some extent. Exactly after treated 24 hours. The steadiness of haemodynamics was maintainable. Conclusion The early CVVH treatment in patients with SAP could alleviate clinical sign obviously in acute reactive period. Key words: Continuous veno-venous hemofileration; Ssevere acute pancreatitis

Improvement of Monocyte Secretion Function in a Porcine Pancreatitis Model by Continuous Dose-Dependent Veno-Venous Hemofiltration

Monocyte and its secreted cytokines play a crucial role in the process of severe acute pancreatitis (SAP). It has been known that continuous veno-venous hemofiltration (CVVH) can partially attenuate the inflammatory process by removal of cytokines, but the effect of CVVH on monocyte secretion function remains unknown. This study investigated the effect of different doses of CVVH on monocyte secretion function as well as the plasma cytokine profile in a SAP porcine model. After successful induction of SAP by pressure-controlled (100 mmHg), intraductal injection of sodium taurocholate (4%, 1 ml/kg) and trypsin (2 U/kg), 24 swine were randomly assigned to 3 groups. Swine in group I (n=8) serving as SAP controls received only standard medical therapy (SMT). Besides SMT, swine in two other groups received zero-balanced CVVH, one hour after the induction of SAP, with low volume fluid exchange (group II, n=8, ultrafiltration rate (UFR) 20 ml/kg/h, LV-CVVH) or high volume (group III, n=8, UFR 100 ml/kg/h, HV-CVVH). Using heparin as anticoagulant, the filter (AN69, Hospal, Lyon, France) was changed every 24 hours. Monocytes were isolated from porcine blood at various timepoints for detection of cytokine secretion (interleukin-6, IL-6; interleukin-10, IL-10; tumor necrosis-a, TNF-a) after LPS stimulus; plasma cytokines were measured simultaneously. CVVH showed a dose-dependent beneficial effect on the animals' survival time. In control animals, plasma pro-inflammatory cytokine levels exhibited a double-phase fluctuation after SAP induction: IL-6 and TNF-alfa rapidly increased to a peak level within 6-12 hours, then dropped to very low level in the late stage. Unlike pro-inflammatory cytokines, the plasma level of anti-inflammatory cytokine IL-10 reached a plateau within 6-12 hours but dropped little. In CVVH-treated animals, the peak-nadir patterns of 3 cytokines were all flattened, most prominently in the HV-CVVH group. Similarly to plasma cytokine patterns, the monocyte ex vivo response to LPS stimulus showed an over-production of cytokines within 6-12 hours, but low production in the late stage. Although unable to totally prevent the abnormality of the monocyte secretion function, CVVH showed a dose-dependent ameliorative effect on it. Monocytes are over-reactive to stimulus in the early stage of SAP, accompanied by a high level of plasma cytokines, and hypo-reactive to stimulus in the late stage of SAP, accompanied with a low level of plasma cytokines. CVVH treatment has a dose-dependent improvement effect on monocyte responsiveness.

Pharmacokinetics and pharmacodynamics of danaparoid during continuous venovenous hemofiltration: a pilot study

BackgroundIn patients with suspected heparin-induced thrombocytopenia (HIT) who need renal replacement therapy, a nonheparin anticoagulant has to be chosen to prevent thrombosis in the extracorporeal circuit. Danaparoid, a low-molecular-weight heparinoid consisting of heparan sulphate, dermatan sulphate, and chondroitin sulphate, is recommended for systemic anticoagulation in patients with HIT. However, there are few data on the use of danaparoid in patients with acute renal failure, especially in patients dependent on renal replacement therapy such as continuous venovenous hemofiltration (CVVH). In the present study, we analyzed the pharmacokinetics and pharmacodynamics of danaparoid during CVVH in patients with suspected HIT.MethodsBased on a mathematical model, a dosing scheme for danaparoid was designed, aiming at anti-Xa levels of 0.5 to 0.7 U/mL, with a maximum of 1.0 U/mL. This dosing scheme was prospectively tested in the first CVVH run of a cohort of five patients with suspected HIT. CVVH with a blood flow rate of 150 mL/minute and a substitution rate of 2,000 mL/hour was performed with a cellulose triacetate membrane. Danaparoid was administered as a continuous infusion of 100 anti-Xa-U/hour after a loading dose of 3,500 anti-Xa-U. Serial measurements of anti-Xa activity and prothrombin fragment F1+2 were performed at baseline, at t = 5, 15, and 30 minutes, and at t = 1, 2, 4, 8, 16, and 24 hours after the danaparoid loading dose.ResultsThe median anti-Xa activity reached a maximum of 1.02 (0.66 to 1.31) anti-Xa-U/mL after 15 minutes and gradually declined to 0.40 (0.15 to 0.58) anti-Xa-U/mL over the span of 24 hours. Target anti-Xa levels were reached from 2 to 12 hours after the loading dose. Median prothrombin fragment F1+2 gradually decreased from 432 (200 to 768) to 262 (248 to 317) pmol/L after 24 hours. No bleeding or thromboembolic events occurred throughout the described treatment period.ConclusionDanaparoid administered by a continuous infusion of 100 anti-Xa-U/hour after a loading dose of 3,500 anti-Xa-U elicited target anti-Xa levels from 2 to 12 hours after the loading dose, without bleeding or thromboembolic events during the described CVVH treatment in patients with suspected HIT.

MARS treatment for a patient presenting with acquired hepatic glutamine synthetase deficiency after orthotopic liver transplantation

We report a 48-year-old man presenting with refractory hyperammonemia after orthotopic liver transplantation. On investigation he was found to have acquired hepatic glutamine synthetase deficiency, a rare condition that occurs after organ transplantations. The patient was started on continuous venovenous hemofiltration treatment, but the hyperammonemia did not respond. The patient was then subjected to molecular adsorption recirculation system (MARS) therapy and the ammonia level gradually improved with successive treatments. In conclusion, the response was unlikely due to the hemofiltration component of MARS alone but more probably due to the removal of putative albumin-bound toxin by the adsorption circuit that had ameliorated the internal milieu of the graft and reversed the enzyme deficiency.

Effects of continuous veno-venous hemofiltration on the serum levels of NO and TNF-α and short-term prognosis in patients with post-traumatic multiple organ dysfunction syndrome

目的 探讨连续性静-静脉血液滤过(CVVH)对创伤后多器官功能障碍综合征(MODS)病人血清一氧化氮(NO)与α-肿瘤坏死因子(TNF-α)浓度及近期预后的影响.方法 17例创伤后MODS病人一经确诊即行床边CVVH.CVVH之前和之后6 h取血和超滤液检测NO与TNF-α浓度.结果 CVVH干预后6 h血清NO浓度峰值与TNF-α浓度峰值与CVVH干预之前比较均有显著性统计学意义,CVVH干预组住院病死率明显低于对照组,滤过液中也能检测到较高浓度的NO和TNF-α.结论 CVVH能够有效清除创伤后MODS病人血中过高的NO和TNF-α并明显改善近期预后。

Experience with continuous venovenous hemofiltration (CVVH) in the ICU: a report from a single center

During the last 7 years in our ICU, CVVH was used as renal support in 101 critically adults (79 M, 22 F, median age 57, range 17–86) with acute renal failure (ARF). Patients who were treated with CVVH for less than 24 hours were excluded from this report. APACHE score at admission was 23 (median, range 8–42). The majority of the patients was on mechanical ventilation (98%) and needed vasopressor support (91%). Vascular access was performed with the use of a blood pump. Conventional heparin was used for anticoagulation in the most of the cases (90%). In 31 of the patients (group A) CVVH was initiated upon their first day of admission while in the rest 70 pts (group B) CVVH was started on the 9th day, median (range 2–32) of their hospitalization in the ICU. Uremia was satisfactory controlled in most of the cases with a mean amount of ultrafiltrate of 38.7 ± 0.6 SEM, l/day (range 27–49.5). Patients of group A remained on CVVH treatment for a median of 5 days (range 1–40), while those of group B for 4.5 days (range 1–29), P = NS. Although serum creatinine levels at the initiation of CVVH did not show any difference between the groups (group A 4.9 ± 0.4 SEM, group B 5.2 ± 0.5 SEM, P = NS), the corresponding BUN level were lower in patients of group A (86.0 ± 7.1 SEM vs 112.8 ± 6.9 SEM, P = 0.021). The duration of hospitalization (days) in the ICU was also lower in the group A patients (10.7 ± 2.2 SEM vs 24.2 ± 2.0 SEM, P = 0.0001). Ten (10) patients of group A (32.2%) and 15 pts of group B (21.4%) were survived and discharged from the ICU, χ2 = NS, with a mean serum creatinine and BUN levels that did not differ between these two groups. The overall mortality was 75.2%. It is concluded that in the ICU the mortality rate of critically ill adults patients with ARF demanding renal support treatment remains high despite the use of CVVH and that the timing of ARF occurrence and CVVH initiation does not exert any major influence on the outcome of these patients.

Congestive heart failure as an indication for continuous renal replacement therapy

Congestive heart failure as an indication for continuous renal replacement therapy

Cytokines clearance during venovenous hemofiltration in the trauma patient

The objective of the study was to investigate whether continuous venovenous hemofiltration (CVVH) would facilitate removal of substantial amounts of tumor necrosis factor (TNF) and interleukin-6 (IL-6) from the circulation in traumatized critically ill patients with multiple organ dysfunction syndrome. The study design was a prospective, nonblind, randomized controlled trial that was set in the trauma intensive care unit of a tertiary university referral hospital. Thirty consecutive critically ill, mechanically ventilated trauma patients with multiple organ dysfunction syndrome (without renal failure) were included in the study. Patients were randomized to either CVVH or conventional treatment. Blood and ultrafiltrate samples were collected from each patient before the initiation of CVVH and after 24, 72, and 168 hours of therapy. In the control group, blood samples were collected during the same periods. In the 30 patients studied, 15 had hemofiltration and 15 did not. Both groups were similar with regard to age (36 ± 18 years v 36 ± 14 years) and severity scores (injury severity score, 32 ± 16 v 30 ± 11; APACHE II score, 22 ± 7 v 21 ± 6; Goris score, 5.2 ± 1.7 v 5.2 ± 1.8). Before CVVH, TNF and IL-6 could be detected in the serum of all patients. The mean concentration of TNF was 17 ± 22 pg/mL in patients and 22 ± 20 pg/mL in control subjects ( P = NS). The mean concentration of IL-6 was 2,153 ± 2,824 pg/mL in patients and 1,774 ± 1,637 pg/mL in control subjects ( P = NS). We found a TNF and IL-6 substantial elimination with CVVH (excretion of TNF [μg/d] at 24, 48, and 168 hours; 112.6 ± 161.2, 105.2 ± 149.4, and 143.1 ± 170.0; excretion of IL-6 [μg/d]: 1,655 ± 719, 3,091 ± 489, and 2,420 ± 366). However, no significant difference was found in serum cytokines concentration between groups during the study: mean serum TNF concentration decreased from the pretreatment level to a mean level of 12 ± 9.6 pg/mL in patients and 21 ± 27 pg/mL in control subjects. Similar results were found with IL-6 concentration that decreased from the pretreatment level to a mean of 554 ± 731 pg/mL in patients and 382 ± 568 pg/mL in control subjects. In conclusion, CVVH is associated with removal of substantial amounts of TNF and IL-6 from the circulation in traumatized critically ill patients, but the profile of these mediators is similar to that of controls, suggesting a nonclinically relevant elimination. Further prospective, randomized, clinical trials are needed to support our results.

Comparison of a Lactate- Versus Acetate-Based Hemofiltration Replacement Fluid in Patients with Acute Renal Failure

The objective of the study was to determine the impact of a lactate- and an acetate-based hemofiltration replacement fluid (HF) on the acid–base status in patients with acute renal failure (ARF) and continuous venovenous hemofiltration (CVVH). The prospective, cohort study was carried out in the intensive care unit of the Heinrich-Heine University Hospital, Düsseldorf, FRG. Subjects were 84 critically ill patients with ARF and CVVH. Fifty-two patients were subjected to lactate-based (group 1) and 32 to acetate-based hemofiltration (group 2). Thirty-eight patients had a septic, 46 a cardiovascular origin of the ARF. Creatinine, BUN, serum bicarbonate, arterial pH, lactate and APACHE II score were noted daily. Mean CVVH duration was 9.8 ± 8.1 days; mortality was 65%. The groups did not differ with regard to the main clinical parameters. Lacate-based hemofiltration led to significantly higher serum bicarbonate and arterial pH values as compared to the acetate-based hemofiltration. Baseline serum bicarbonate values were 23.3 ± 8.3 mmol/L in group 1 and 21.6 ± 4.3 mmol/L in group 2 (NS); values at 48 h after initiating CVVH treatment were 25.7 ± 3.8 mmol/L and 20.6 ± 3.1 mmol/L, respectively (p < 0.001). Arterial pH prior to CVVH treatment was 7.36 ± 0.1 in group 1 and 7.34 ± 0.1 in group 2 (NS), and 7.43 ± 0.07 versus 7.37 ± 0.06 (p < 0.001) on day 2. These findings were maintained throughout therapy. While a lack of increase in serum bicarbonate and arterial pH was correlated to a poor prognosis in lactate-based hemofiltration, no such observation could be made in acetate-based hemofiltration. Septic patients did not differ in their acid–base status from nonseptic patients. Lactic acidosis occurred in 8 septic patients irrespective of the substitution fluid. All 8 patients died. There was a significant increase in HCO3 and arterial pH values in lactate-based as compared to acetate-based HF.