High-volume hemofiltration in sepsis and SIRS: current concepts and future prospects.

In recent years, a number of techniques have been studied and developed in the field of renal replacement therapy in the septic patient. Manipulation of ultrafiltrate dose, membrane porosity, mode of clearance, and combinations of techniques have yielded promising findings. However, at present, conclusive evidence based on well-designed, randomized controlled trials remains scarce, limiting the practical implementation of many techniques in daily practice outside the context of a study. From the few well-designed and documented studies that we have so far, it is safe to say that optimalization of delivered dose in renal replacement therapy has a proven positive effect. An ultrafiltration rate between 35 and 45 ml/kg/h, with adjustment for predilution and down time, can be recommended for the septic patient until other data are available. The results of further dose outcome studies with higher ultrafiltration rates will likely be the stepping stone to further improvements in daily clinical practice. (c) 2009 S. Karger AG, Basel.