• Am. J. Kidney Dis. · Oct 2016

    Randomized Controlled Trial Comparative Study

    High-Dose Versus Conventional-Dose Continuous Venovenous Hemodiafiltration and Patient and Kidney Survival and Cytokine Removal in Sepsis-Associated Acute Kidney Injury: A Randomized Controlled Trial.

    • Jung Tak Park, Hajeong Lee, Youn Kyung Kee, Seokwoo Park, Hyung Jung Oh, Seung Hyeok Han, Kwon Wook Joo, Chun-Soo Lim, Yon Su Kim, Shin-Wook Kang, Tae-Hyun Yoo, Dong Ki Kim, and HICORES Investigators.
    • Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea.
    • Am. J. Kidney Dis. 2016 Oct 1; 68 (4): 599-608.

    BackgroundSoluble inflammatory mediators are known to exacerbate sepsis-induced acute kidney injury (AKI). Continuous renal replacement therapy (CRRT) has been suggested to play a part in immunomodulation by cytokine removal. However, the effect of continuous venovenous hemodiafiltration (CVVHDF) dose on inflammatory cytokine removal and its influence on patient outcomes are not yet clear.Study DesignProspective, randomized, controlled, open-label trial.Setting & ParticipantsSeptic patients with AKI receiving CVVHDF for AKI.InterventionConventional (40mL/kg/h) and high (80mL/kg/h) doses of CVVHDF for the duration of CRRT.OutcomesPatient and kidney survival at 28 and 90 days, circulating cytokine levels.Results212 patients were randomly assigned into 2 groups. Mean age was 62.1 years, and 138 (65.1%) were men. Mean intervention durations were 5.4 and 6.2 days for the conventional- and high-dose groups, respectively. There were no differences in 28-day mortality (HR, 1.02; 95% CI, 0.73-1.43; P=0.9) or 28-day kidney survival (HR, 0.96; 95% CI, 0.48-1.93; P=0.9) between groups. High-dose CVVHDF, but not the conventional dose, significantly reduced interleukin 6 (IL-6), IL-8, IL-1b, and IL-10 levels. There were no differences in the development of electrolyte disturbances between the conventional- and high-dose groups.LimitationsSmall sample size. Only the predilution CVVHDF method was used and initiation criteria were not controlled.ConclusionsHigh CVVHDF dose did not improve patient outcomes despite its significant influence on inflammatory cytokine removal. CRRT-induced immunomodulation may not be sufficient to influence clinical end points.Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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