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Kidney Week

Abstract: PO0256

Survival Comparison Between Continuous Venovenous Hemodiafiltration (CVVHDF) and Continuous Venovenous Hemofiltration (CVVH) for Septic AKI

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Author

  • Jang, Mun, Yemidam Hospital, Cheonjusi, Korea (the Republic of)
Background

The mortality rate of septic acute kidney injury (AKI) remains high despite improvements in renal replacement technology. Adding dialysis to continuous veno-venous hemofiltration (CVVH) can increase survival in these patients, although hemofiltration leads to better clearance of inflammatory mediators in sepsis than hemodialysis. We tested whether continuous veno-venous hemodiafiltration (CVVHDF) is more effective than CVVH with the same net effluent according to body weight in intensive care unit (ICU) patients with septic AKI.

Methods

CVVHDF was performed using a Prismaflex (©Baxter International, Deerfield, IL, USA) with a blood flow rate (BFR) of 150 ml/min at a dialysate flow rate 20 ml/kg/hour, in addition to a replacement fluid flow rate of 20 ml/kg/hour. In contrast, the replacement fluid flow rate of CVVH was 40 ml/kg/hour. The patient’s removal rate was individually adjusted by attending staff based on clinical status.

Results

In this prospective randomized pilot study, 100 patients were assigned to CVVH (n=47, M:F=25:22, age 64±15 years) or CVVHDF (n=49, M:F=30:19, age 65±11 years). Baseline characteristics including age, sex, body weight, serum creatinine, blood urea nitrogen (BUN), beta-2 microglobulin, Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores did not vary between the two groups. There were no significant differences in the reduction ratios of serum creatinine, BUN, beta-2 microglobulin, APACHE II and SOFA scores between the two groups. Seven-, 28-, and 60-day survival also did not vary.

Conclusion

In conclusion, CVVH and CVVHDF led to similar clearance of waste products and survival at the same net effluent in this study. Future large-scale randomized prospective studies will be needed to confirm these results in critically ill patients with septic AKI.

Outcomes by treatment groups
 CVVHDF groupCVVHF groupp-value
Total CRRT days8.5±8.97.4±8.00.57
Total ICU days15.8±18.215.8±15.50.99
Renal recovery at hospital discharge (%)31200.29
Survival (%) 
7 days67700.82
28 days47451.00
60 days31250.64

CRRT, continous renal replacement therapy; CVVHDF, continous veno-venous hemodiafiltration; CVVHF, continous veno-venous hemofiltration; ICU, intensive care unit.