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Kidney Week

Abstract: PO0257

Systematic Review of the Effects of High-Volume High-Flow (HVHF) in Pediatric Sepsis

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Raina, Rupesh, Cleveland Clinic, Akron, Ohio, United States
  • Chakraborty, Ronith, Cleveland Clinic, Akron, Ohio, United States
  • Singh, Siddhartha S., Cleveland Clinic, Akron, Ohio, United States
  • Nair, Nikhil, Cleveland Clinic, Akron, Ohio, United States
Background


Pediatric sepsis is a significant public health issue. This condition is exacerbated by the presence of excess serum creatinine and inflammatory cytokines that lead to deleterious effects upon the body. The current standard of care involves the use of continuous kidney replacement therapy to remove harmful cytokines until the body returns to homeostasis. In order to promote faster clearance and reduced stay in the ICU, high volume high flow has been posited as a potential new modality of choice. However there is a paucity of studies to fully elucidate its benefits.

Methods

A literature search was done using PubMed/Medline and Embase. Keywords used while conducting the literature search were, “hemofiltration OR haemofiltration OR hemodiafiltration” AND “high-volume”. The literature was reviewed by two independent reviewers, who independently assessed the quality of randomized controlled trials by using the Cochrane risk of bias tool for RCTs And Newcastle Ottawa Scale (NOS) for assessing the quality of non-randomized controlled trials. Data was combined from studies with similar design.

Results

The primary endpoint of all cause mortality was found to be reduced by 40% across all of the pooled studies. For secondary endpoints, significant reductions of serum creatinine were found after 24 and 48 hours of use compared to the current standard of care. Additionally, duration of ICU stay and treatment course was found to be significantly shorter in HVHF patients than the current standard of care. Finally the rate of adverse effects were analyzed and there was no difference in the proportion of patients developing hypokalemia, hyperkalemia, hypernatremia or hyponatremia. The proportion of patients developing hyperglycemia was higher in patients undergoing HVHF whereas the proportions of patients developing bleeding was significantly less in patients undergoing HVHF. One study reported a total number of adverse events between the two groups which were significantly lesser in patients undergoing HVHF.

Conclusion

HVHF shows promise as a modality to treat pediatric patients with sepsis.In order to confirm the benefits of this modality, future studies need significantly more patients for analysis.