Comparison of Sustained Hemodiafiltration With Continuous Venovenous Hemodiafiltration for the Treatment of Critically Ill Patients With Acute Kidney Injury

Abstract

Despite improvements in medical care, the mortality of critically ill patients with acute kidney injury (AKI) who require renal replacement therapy (RRT) remains high. We describe a new approach, sustained hemodiafiltration, to treat patients who suffered from acute kidney injury and were admitted to intensive care units (ICUs). In our study, 60 critically ill patients with AKI who required RRT were treated with either continuous venovenous hemodiafiltration (CVVHDF) or sustained hemodiafiltration (S-HDF). The former was performed by administering a postfilter replacement fluid at an effluent rate of 35 mL/kg/h, and the latter was performed by administering a postfilter replacement fluid at a dialysate-flow rate of 300-500 mL/min. The S-HDF was delivered on a daily basis. The baseline characteristics of the patients in the two treatment groups were similar. The primary study outcome--survival until discharge from the ICU or survival for 30 days, whichever was earlier--did not significantly differ between the two groups: 70% after CVVHDF and 87% after S-HDF. The hospital-survival rate after CVVHDF was 63% and that after S-HDF was 83% (P < 0.05). The number of patients who showed renal recovery at the time of discharge from the ICU and the hospital and the duration of the ICU stay significantly differed between the two treatments (P < 0.05). Although there was no significant difference between the mean number of treatments performed per patient, the mean duration of daily treatment in the S-HDF group was 6.5 +/- 1.0 h, which was significantly shorter. Although the total convective volumes--the sum of the replacement-fluid and fluid-removal volumes--did not differ significantly, the dialysate-flow rate was higher in the S-HDF group. Our results suggest that in comparison with conventional continuous RRT, including high-dose CVVHDF, more intensive renal support in the form of postdilution S-HDF will decrease the mortality and accelerate renal recovery in critically ill patients with AKI.

Modality of RRT and Recovery of Kidney Function after AKI in Patients Surviving to Hospital Discharge

“…However, our findings (19) are different from those of Wald et al (4) as well as many of the previous observational studies (1,(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50). Instead, our findings are more consistent with previous RCTs (1,15,16,(30)(31)(32)51,52). It is unclear why our findings diverge from other large retrospective studies and show no increased hazard for nonrecovery from AKI with IHD.…”

Renal replacement therapy for acute kidney injury

“…RCTs comparing these two modalities have failed to provide evidence for the survival benefits of CRRT over IHD [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46]. The clinical question "which is the best treatment strategy for critically ill patients with AKI requiring RRT ?…”

Extended Daily Dialysis Versus Continuous Renal Replacement Therapy for Acute Kidney Injury: A Meta-analysis

“…They found no significant difference in mortality between the 2 groups. [6][7][8] However, a recent study reported that EDD might reduce mortality in patients with AKI in comparison to CRRT. 9 Thus, we sought to systematically review the current literature and analyze all studies comparing EDD to CRRT for the treatment of AKI in critical illness.…”