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, SeungHyeok Han, Shin-Wook Kang, TaeHyun 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

28 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

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Hemodiafiltration
Acute Kidney Injury
Sepsis
Randomized Controlled Trials
Cytokines
Kidney
Renal Replacement Therapy
Immunomodulation
Interleukin-8
Interleukin-10
Sample Size
Electrolytes
Interleukin-6
Prospective Studies
Mortality

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Park, Jung Tak ; Kee, Youn Kyung ; Oh, Hyung Jung ; Han, SeungHyeok ; Kang, Shin-Wook ; Yoo, TaeHyun ; Lee, Hajeong ; Park, Seokwoo ; Joo, Kwon Wook ; Lim, Chun Soo ; Kim, Yon Su ; Kim, Dong Ki ; Joo, Kwon Wook ; Lim, Chun Soo ; Kim, Yon Su ; Kim, Dong Ki ; Jo, Hyung Ah ; Han, Miyeun ; Lee, Sunhwa ; Kim, Eun Young ; Yang, Ji Soo ; Lee, Mi Jung ; Kwon, Young Eun ; Park, Kyoung Sook ; Kee, Youn Kyung ; Han, Seung Gyu ; Han, In Mee ; Yoon, Chang Yun ; Ryu, Geun Woo ; Jhee, Jong Hyun ; Kim, Min Hee ; Kim, Yeon Ji ; Jang, Yoon Hee ; Kim, Mi Rae ; Song, Kwnag Ju ; Kim, Mi Ae ; Hyun, Ju Young ; Choi, Byeol Na. / 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. In: American Journal of Kidney Diseases. 2016 ; Vol. 68, No. 4. pp. 599-608.
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title = "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",
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.",
author = "Park, {Jung Tak} and Kee, {Youn Kyung} and Oh, {Hyung Jung} and SeungHyeok Han and Shin-Wook Kang and TaeHyun Yoo and Hajeong Lee and Seokwoo Park and Joo, {Kwon Wook} and Lim, {Chun Soo} and Kim, {Yon Su} and Kim, {Dong Ki} and Joo, {Kwon Wook} and Lim, {Chun Soo} and Kim, {Yon Su} and Kim, {Dong Ki} and Jo, {Hyung Ah} and Miyeun Han and Sunhwa Lee and Kim, {Eun Young} and Yang, {Ji Soo} and Lee, {Mi Jung} and Kwon, {Young Eun} and Park, {Kyoung Sook} and Kee, {Youn Kyung} and Han, {Seung Gyu} and Han, {In Mee} and Yoon, {Chang Yun} and Ryu, {Geun Woo} and Jhee, {Jong Hyun} and Kim, {Min Hee} and Kim, {Yeon Ji} and Jang, {Yoon Hee} and Kim, {Mi Rae} and Song, {Kwnag Ju} and Kim, {Mi Ae} and Hyun, {Ju Young} and Choi, {Byeol Na}",
year = "2016",
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Park, JT, Kee, YK, Oh, HJ, Han, S, Kang, S-W, Yoo, T, Lee, H, Park, S, Joo, KW, Lim, CS, Kim, YS, Kim, DK, Joo, KW, Lim, CS, Kim, YS, Kim, DK, Jo, HA, Han, M, Lee, S, Kim, EY, Yang, JS, Lee, MJ, Kwon, YE, Park, KS, Kee, YK, Han, SG, Han, IM, Yoon, CY, Ryu, GW, Jhee, JH, Kim, MH, Kim, YJ, Jang, YH, Kim, MR, Song, KJ, Kim, MA, Hyun, JY & Choi, BN 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, vol. 68, no. 4, pp. 599-608. https://doi.org/10.1053/j.ajkd.2016.02.049

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

In: American Journal of Kidney Diseases, Vol. 68, No. 4, 01.10.2016, p. 599-608.

Research output: Contribution to journalArticle

TY - JOUR

T1 - High-Dose Versus Conventional-Dose Continuous Venovenous Hemodiafiltration and Patient and Kidney Survival and Cytokine Removal in Sepsis-Associated Acute Kidney Injury

T2 - A Randomized Controlled Trial

AU - Park, Jung Tak

AU - Kee, Youn Kyung

AU - Oh, Hyung Jung

AU - Han, SeungHyeok

AU - Kang, Shin-Wook

AU - Yoo, TaeHyun

AU - Lee, Hajeong

AU - Park, Seokwoo

AU - Joo, Kwon Wook

AU - Lim, Chun Soo

AU - Kim, Yon Su

AU - Kim, Dong Ki

AU - Joo, Kwon Wook

AU - Lim, Chun Soo

AU - Kim, Yon Su

AU - Kim, Dong Ki

AU - Jo, Hyung Ah

AU - Han, Miyeun

AU - Lee, Sunhwa

AU - Kim, Eun Young

AU - Yang, Ji Soo

AU - Lee, Mi Jung

AU - Kwon, Young Eun

AU - Park, Kyoung Sook

AU - Kee, Youn Kyung

AU - Han, Seung Gyu

AU - Han, In Mee

AU - Yoon, Chang Yun

AU - Ryu, Geun Woo

AU - Jhee, Jong Hyun

AU - Kim, Min Hee

AU - Kim, Yeon Ji

AU - Jang, Yoon Hee

AU - Kim, Mi Rae

AU - Song, Kwnag Ju

AU - Kim, Mi Ae

AU - Hyun, Ju Young

AU - Choi, Byeol Na

PY - 2016/10/1

Y1 - 2016/10/1

N2 - 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.

AB - 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.

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U2 - 10.1053/j.ajkd.2016.02.049

DO - 10.1053/j.ajkd.2016.02.049

M3 - Article

C2 - 27084247

AN - SCOPUS:84964322511

VL - 68

SP - 599

EP - 608

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

SN - 0272-6386

IS - 4

ER -