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

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• 作者：Jung Tak Park ; MD ; PhD¹ ; ^&lowast ; ; Hajeong Lee ; MD² ; ^&lowast ; ; Youn Kyung Kee ; MD¹ ; Seokwoo Park ; MD² ; Hyung Jung Oh ; MD¹ ; Seung Hyeok Han ; MD ; PhD¹ ; Kwon Wook Joo ; MD ; PhD² ; ³ ; Chun-Soo Lim ; MD ; PhD² ; ³ ; Yon Su Kim ; MD ; PhD² ; ³ ; Shin-Wook Kang ; MD ; PhD¹ ; Tae-Hyun Yoo ; MD ; PhD¹ ; ^{yoosy0316@yuhs.ac" class="auth_mail" title="E-mail the corresponding author} ; Dong Ki Kim ; MD ; PhD² ; ³ ; ^{dkkim73@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; on behalf of the HICORES Investigators^&dagger ; ; Hyung Ah Jo ; MD ; Miyeun Han ; MD ; Sunhwa Lee ; MD ; Eun Young Kim ; RN ; Ji-Soo Yang ; RN ; Mi Jung Lee ; MD ; Young Eun Kwon ; MD ; Kyoung Sook Park ; MD ; Youn Kyung Kee ; MD ; Seung Gyu Han ; MD ; In Mee Han ; MD ; Chang Yun Yoon ; MD ; Geun Woo Ryu ; MD ; Jong Hyun Jhee ; MD ; Hyung Woo Kim ; MD ; Seohyun Park ; MD ; Su-Young Jung ; MD ; Eun Kyoung Kim ; RN ; Min Hee Kim ; RN ; Yeon Ji Kim ; RN ; Yoon Hee Jang ; RN ; Mi Rae Kim ; RN ; Kwnag Ju Song ; RN ; Mi Ae Kim ; RN ; Ju Young Hyun ; RN ; Byeol Na Choi ; RN
• 刊名：American Journal of Kidney Diseases
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：68
• 期：4
• 页码：599-608
• 全文大小：692 K

文摘

Soluble 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 Design

Prospective, randomized, controlled, open-label trial.

Setting & Participants

Septic patients with AKI receiving CVVHDF for AKI.

Intervention

Conventional (40 mL/kg/h) and high (80 mL/kg/h) doses of CVVHDF for the duration of CRRT.

Outcomes

Patient and kidney survival at 28 and 90 days, circulating cytokine levels.

Results

212 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.

Limitations

Small sample size. Only the predilution CVVHDF method was used and initiation criteria were not controlled.

Conclusions

High 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.