A double-blind randomized controlled trial of high cutoff versus standard hemofiltration in critically ill patients with acute kidney injury

Rafidah Atan, Leah Peck, John Prowle, Elisa Licari, Glenn M. Eastwood, Markus Storr, Hermann Goehl, Rinaldo Bellomo

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    Abstract

    Objectives: In critically ill patients with acute kidney injury receiving vasopressors, high cytokine levels may sustain the shock state. High cutoff hemofiltration achieves greater cytokine removal in ex vivo and in animal models and may reduce the duration of shock but may also increase albumin losses. Design: This was a single-center double-blind randomized controlled trial comparing continuous venovenous hemofiltration-high cutoff to continuous venovenous hemofiltration-standard. Setting: Tertiary care hospital in Australia. Patients: Vasopressor-dependent patients in acute kidney injury who were admitted to the ICU. Interventions: Norepinephrine-free time were calculated in critically ill vasopressor-dependent patients in acute kidney injury, randomized to either continuous venovenous hemofiltration-high cutoff or continuous venovenous hemofiltration-standard. Measurement and Main Results: A total of 76 patients were randomized with the following characteristics (continuous venovenous hemofiltration-high cutoff vs continuous venovenous hemofiltration-standard); median age of 65 versus 70 year, percentage of males 47% versus 68%, and median Acute Physiology and Chronic Health Evaluation scores of 25 versus 23.5. The median hours of norepinephrine-free time at day 7 were 32 (0-110.8) for continuous venovenous hemofiltration-high cutoff and 56 hours (0-109.3 hr) (p = 0.520) for continuous venovenous hemofiltration-standard. Inhospital mortality was 55.6% with continuous venovenous hemofiltration-high cutoff versus 34.2% with continuous venovenous hemofiltration-standard (adjusted odds ratio, 2.49; 95% CI, 0.81-7.66; p = 0.191). There was no significant difference in time to cessation of norepinephrine (p = 0.358), time to cessation of hemofiltration (p = 0.563), and filter life (p = 0.21). Serum albumin levels (p = 0.192) were similar and the median dose of IV albumin given was 90 grams (20-212 g) for continuous venovenous hemofiltration-high cutoff and 80 grams (15-132 g) for continuous venovenous hemofiltration-standard (p = 0.252). Conclusions: In critically ill patients with acute kidney injury, continuous venovenous hemofiltration-high cutoff did not reduce the duration of vasopressor support or mortality or change albumin levels compared with continuous venovenous hemofiltration-standard.

    Original languageEnglish
    Pages (from-to)e988-e994
    Number of pages7
    JournalCritical Care Medicine
    Volume46
    Issue number10
    DOIs
    Publication statusPublished - Oct 2018

    Keywords

    • Acute kidney injury
    • Blood purification
    • Critical illness
    • Hemofiltration
    • High cutoff filter
    • Super high flux filter

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