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Abstract: FR-PO137

Sepsis-Associated AKI (SA-AKI) Requiring Kidney Replacement Therapy (KRT): Role of Hemofiltrate Reinfusion (HFR)-Supra on Inflammation and Outcome

Session Information

  • AKI: Outcomes, RRT
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials


  • Gernone, Giuseppe, ASL Bari, Bari, Puglia, Italy
  • Russo, Michele, ASL Bari, Bari, Puglia, Italy

Sepsis is life-threatening organ dysfunction caused by dysregulated body response to an infection. Mortality rate ranging over 60% for septic shock. AKI is final common pathway of this immune dysregulation leading to systemic inflammation (SI) due to uncontrolled circulating levels of pro-inflammatory mediators and cytokine induced direct organ damage. KRT is often required in SA-AKI and could improve SI removing pathogens and inflammatory factors. Various blood purification techniques have been used: HCO/MCO membranes, hemoperfusion, plasma filtration/adsorption and, anecdotal, Hemo Filtrate Reinfusion Supra (HFR): endogenous reinfusion HDF based on adsorbing resin cartridge that remove pro-inflammatory cytokines but whose full spectrum is not yet know. Aim of this study is to test HFR on outcome of SA-AKI in critically ill pts.


Retrospective observational study evaluated 8 SA-AKI pts requiring RRT. All were treated with daily HFR(Bellco-Medtronic, Italy), mean of 8.3 ±5.4 treatments. We daily assessed (as mean ±SD): urea, sCr, CRP, procalcitonin (PCT), WBC, myoglobin(Myo), albumin; in addition need for vasopressor and outcome. AKI was defined according to KDIGO.


The mean age was 74.1±9.4 years, 6 pts were male (75%). Over 30% obese, 20% with nephropathies, some hypertensive, with diabetes or COPD. HFR: Qb= 250 ±18.8 ml/m, TT 238.7 ±27.7m. HFR confirm valid URR, highly significant abatement of CRP (271.7 ± 68.4 85.7 ± 61.1 p< 0.0003), meaningful cut of PCT (65.7 ±65.9 10.5 ±20.2 p< 0.03) and Myoglobin (3648.5 ± 1709.2 511.7 ± 435.9 p < 0.01), stable Albumin. Lower need of vasopressor (13.5± 3.8 7.5± 3.1 p < 0.002) highlights improved hemodynamic instability with no poor intradialytic compliance. 3 pts not survived (2 for surgical,1 for pulmonary complications) everyone else had renal recovery.


HFR decrease SI and support renal recovery in SA-AKI pts, even in the not survived. The sorbent cartridge remove many proinflammatory cytokines, that lead to improved MAPs and lower critical illness scores, and allow to eliminate myoglobin too. Finally HFR-Supra is the cheapest technique for SA-AKI in comparison to the other (eg CRRT, HCO, Cytosorb). There is no study on HFR in SA-AKI and very few experience on his use to hypermyoglobinemia. Larger studies need to confirm our evidence but, in the meantime,we could help to build a new scientific evidence.