A pilot randomized study comparing high and low volume hemofiltration on vasopressor use in septic shock

Abstract

HVHF decreased vasopressor requirement and tended to increase urine output in septic shock patients with renal failure. However, a larger trial is required to confirm our results and perhaps to show a benefit in survival.

Clinical review: Blood purification for sepsis

“…In a randomized cross-over study of 11 patients with septic shock and multi-organ failure, an 8-hour period of HVHF (6 L/hour) was associated with a greater reduction in norepinephrine requirements in comparison with a similar period of CVVH (1 L/hour) [26]. Reduction of vasopressor requirements with HVHF was also found more recently in a pilot randomized study comparing CVVH at 65 mL/kg per hour versus 35 mL/kg per hour in 20 septic shock patients with acute kidney injury [27]. Large randomized controlled studies of HVHF in septic shock which use mortality as the primary outcome are lacking.…”

Extracorporeal blood purification for sepsis

“…The results showed that HVHF was associated with a greater reduction in vasopressor use. A study by Boussekey et al 58 (HVHF 65 mL/kg/h vs control 35 mL/kg/h; n=20) yielded similar findings and showed no survival benefit of HVHF over conventional CVVH. Multiple non-randomised studies showed decreased mortality with HVHF for septic shock patients but most of the studies were relatively small.…”

“…57 Only two RCTs that investigated the potential benefit of HVHF over conventional CVVH in septic patients were available before the publication of the landmark trial (highvolume versus standard-volume haemofiltration for septic shock patients with acute kidney injury study) in 2013. 57,58 Cole et al 57 performed the first randomised crossover clinical trial that involved 11 patients with septic shock and multi-organ failure. Patients were assigned to either 8 hours of HVHF (6 L/h) or 8 hours of standard CVVH (1 L/h) in a random order.…”

Continuous Renal Replacement Therapies in Patients with Severe Sepsis and Septic Shock

“… In a pilot prospective study, 20 patients with septic shock and acute renal failure were randomly assigned to either high (65 mL/kg per hour) or low volume (35 mL/kg per hour) hemofiltration (36). High volume hemofiltration was associated with decreased mean norepinephrine dose and increased urine output.…”

“…However, the evidence based on randomised controlled trials is consistent with that of mortality. Only one study with significant methodological limitations reported a reduction in the use of vasopressors in the experimental group (36), and none of the trials reviewed reported an improvement in gas exchange, duration of mechanical ventilation, development of MODS or length of stay. Respect to other outcomes, two recent meta-analyses (77,78) found no effect of high-dose renal replacement therapy on dialysis dependence or length of stay in patients with ARF.…”