Jung Tak Park1, Hajeong Lee2, Youn Kyung Kee1, Seokwoo Park2, Hyung Jung Oh1, Seung Hyeok Han1, Kwon Wook Joo3, Chun-Soo Lim3, Yon Su Kim3, Shin-Wook Kang1, Tae-Hyun Yoo4, Dong Ki Kim5. 1. Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea. 2. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. 3. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Kidney Research Institute, Seoul National University, Seoul, Korea. 4. Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea. Electronic address: yoosy0316@yuhs.ac. 5. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Kidney Research Institute, Seoul National University, Seoul, Korea. Electronic address: dkkim73@gmail.com.
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 (40mL/kg/h) and high (80mL/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.
RCT Entities:
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 (40mL/kg/h) and high (80mL/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.
Authors: Sadudee Peerapornratana; Carlos L Manrique-Caballero; Hernando Gómez; John A Kellum Journal: Kidney Int Date: 2019-06-07 Impact factor: 10.612
Authors: Rinaldo Bellomo; John A Kellum; Claudio Ronco; Ron Wald; Johan Martensson; Matthew Maiden; Sean M Bagshaw; Neil J Glassford; Yugeesh Lankadeva; Suvi T Vaara; Antoine Schneider Journal: Intensive Care Med Date: 2017-03-31 Impact factor: 17.440