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

Jung Tak Park, Youn Kyung Kee, Hyung Jung Oh, Seung Hyeok Han, Shin Wook Kang, Tae Hyun Yoo, Hajeong Lee, Seokwoo Park, Kwon Wook Joo, Chun Soo Lim, Yon Su Kim, Dong Ki Kim, Kwon Wook Joo, Chun Soo Lim, Yon Su Kim, Dong Ki Kim, Hyung Ah Jo, Miyeun Han, Sunhwa Lee, Eun Young KimJi Soo Yang, Mi Jung Lee, Young Eun Kwon, Kyoung Sook Park, Youn Kyung Kee, Seung Gyu Han, In Mee Han, Chang Yun Yoon, Geun Woo Ryu, Jong Hyun Jhee, Min Hee Kim, Yeon Ji Kim, Yoon Hee Jang, Mi Rae Kim, Kwnag Ju Song, Mi Ae Kim, Ju Young Hyun, Byeol Na Choi

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Background 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.

Original languageEnglish
Pages (from-to)599-608
Number of pages10
JournalAmerican Journal of Kidney Diseases
Volume68
Issue number4
DOIs
Publication statusPublished - 2016 Oct 1

All Science Journal Classification (ASJC) codes

  • Nephrology

Fingerprint Dive into the research topics of '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'. Together they form a unique fingerprint.

  • Cite this

    Park, J. T., Kee, Y. K., Oh, H. J., Han, S. H., Kang, S. W., Yoo, T. H., Lee, H., Park, S., Joo, K. W., Lim, C. S., Kim, Y. S., Kim, D. K., Joo, K. W., Lim, C. S., Kim, Y. S., Kim, D. K., Jo, H. A., Han, M., Lee, S., ... Choi, B. N. (2016). 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. American Journal of Kidney Diseases, 68(4), 599-608. https://doi.org/10.1053/j.ajkd.2016.02.049