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Kidney Week

Abstract: FR-PO453

Efficacy and Safety of High-Volume Hemofiltration (HVHF) in Patients with Septic Shock and AKI: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Edding, Sherida Naing, St. Luke's Medical Center - Global City, Taguig City, Philippines
  • Cabral, Brian Michael I., St. Luke's Medical Center - Global City, Taguig City, Philippines
Background

Septic Shock is among the most common causes of death in the intensive care unit (ICU). The underlying pathophysiology involves an overactive immune response. It has been theorized that blood purification technique that reduces the levels of inflammatory cytokines and/or bacterial toxins could mitigate this response. High-volume hemofiltration (HVHF) is a blood purification technique that has been studied to improve outcome associated with septic shock. Our aim is to do a systematic review of randomized controlled trials that assessed the use of HVHF in septic shock.

Methods

A comprehensive literature search from the PubMed, Embase, Cochrane Library, and Ovid was performed with the following search terms: Hemofiltration, Septic Shock, Acute Kidney Injury. The search was limited to randomized-controlled trials that compared HVHF to Conventional (as dictated by the Surviving Sepsis Guidelines) and/or Standard-Volume Hemofiltration (SVHF). Six prospective clinical trials were selected and analysed using Cochrane Revman v5.3. The primary outcome was 28-day mortality. Other outcomes assessed were dialysis dependence, length of ICU and hospital stay, vasopressor requirement and adverse events.

Results

Six trials comprising 745 patients were selected. 373 patients treated with HVHF and 372 patients in the control group were included. Pooled analysis of the 6 trials for 28-day mortality did not show a statistically significant difference between HVHF and control (745 participants, OR: 0.90, 95% CI 0.67-1.21). There were no noted significant difference between groups for any of the secondary outcomes. Adverse events, including electrolyte abnormalities and secondary infections, were more commonly observed in HVHF-treated patients, although reporting was inconsistent across studies.

Conclusion

There is insufficient evidence to support the therapeutic benefit for routine use of high-volume hemofiltration in patients with septic shock. Larger trails are needed to fully assess clinically relevant outcomes as well as cost-effectiveness.

Figure 1. Forest Plot for 28-Day Mortality