Continuous venovenous hemofiltration versus extended daily hemofiltration in patients with septic acute kidney injury: a retrospective cohort study

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• 作者：Zhiping Sun (27)
  Hong Ye (27)
  Xia Shen (27)
  Hongdi Chao (27)
  Xiaochun Wu (27)
  Junwei Yang (27)
  
  27. Center of Kidney Disease ; Second Affiliated Hospital ; Nanjing Medical University ; 262 North Zhongshan Road ; Jiangsu Province ; Nanjing ; 210003 ; China
  
• 刊名：Critical Care
• 出版年：2014
• 出版时间：April 2014
• 年：2014
• 卷：18
• 期：2
• 全文大小：225 KB
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• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Introduction Whether continuous venovenous hemofiltration (CVVHF) is superior to extended daily hemofiltration (EDHF) for the treatment of septic AKI is unknown. We compared the effect of CVVHF (greater than 72 hours) with EDHF (8 to 12 hours daily) on renal recovery and mortality in patients with severe sepsis or septic shock and concurrent acute kidney injury (AKI). Methods A retrospective analysis of 145 septic AKI patients who underwent renal replacement therapy (RRT) between July 2009 and May 2013 was performed. These patients were treated by CVVHF or EDHF with the same polyacrylonitrile membrane and bicarbonate-based buffer. The primary outcomes measured were occurrence of renal recovery and all-cause mortality by 60 days. Results Sixty-five and eighty patients were treated with CVVHF and EDHF, respectively. Patients in the CVVHF group had significantly higher recovery of renal function (50.77% of CVVHF group versus 32.50% in the EDHF group, P鈥?鈥?.026). Median time to renal recovery was 17.26 days for CVVHF patients and 25.46 days for EDHF patients (P鈥?鈥?.039). Sixty-day all-cause mortality was similar between CVVHF and EDHF groups (44.62%, and 46.25%, respectively; P鈥?鈥?.844). 55.38% of patients on CVVHF and 28.75% on EDHF developed hypophosphatemia (P鈥?鈥?.001). The other adverse events related to RRT did not differ between groups. On multivariate analysis, including physiologically clinical relevant variables, CVVHF therapy was significantly associated with recovery of renal function (HR 3.74; 95% CI 1.82 to 7.68; P鈥?鈥?.001), but not with mortality (HR 0.69; 95% CI 0.34 to 1.41; P鈥?鈥?.312). Conclusions Patients undergoing CVVHF therapy had significantly improved renal recovery independent of clinically relevant variables. The patients with septic AKI had similar 60-day all-cause mortality rates, regardless of type of RRT.