Early isovolaemic haemofiltration in oliguric patients with septic shock

Abstract

In patients with septic shock, EIHF was associated with improved gas exchange, haemodynamics, greater likelihood of successful weaning and greater 28-day survival compared with conventional therapy.

High versus standard-volume haemofiltration in hyperdynamic porcine peritonitis: effects beyond haemodynamics?

“…35 ml/kg per hour. Although our observation corroborates recent reports, both from animal [16,19,20,27] and clinical [9][10][11][12][13][14] trials, demonstrating a favorable effect on systemic haemodynamic, an ultrafiltration rate of 100 ml/ kg per hour failed to be superior over 35 ml/kg per hour in its capability to ameliorate disturbances in other mutually independent biological systems. These results could indicate, among other things, that the value of haemodynamic improvement as a surrogate marker for efficacy of haemofiltration might be ambiguous.…”

“…Data are median and 25th and 75th quartiles group; (2) despite favorable effects on vasopressor requirements, neither of the haemofiltration doses beneficially modulated the sepsis-induced alterations in microcirculatory perfusion and energy metabolism, endothelial dysfunction and oxidative stress. The reduced need for vasopressor support observed in both haemofiltration groups is consistent with previous experimental [16,19,20,27] and human studies [9,11,13,14]. The unchanged cardiac performance and comparable cardiac preload suggest an influence of haemofiltration on pathways implicated in the control of vascular tone, such as cytokine-driven iNOS-generated overproduction of nitric oxide or opening of ATP-sensitive potassium channels [28,29].…”

“…In addition, Ronco et al [5] suggested a beneficial trend in survival when further increasing the dose of haemofiltration up to 45 ml/kg per hour in a small subgroup of septic patients. Although limited in their robustness and methodological aspects, several human [9][10][11][12][13][14][15] and animal [16][17][18][19][20] studies further support the concept of high-volume haemofiltration (HVHF) in the treatment of endotoxemia or septic shock, mainly by demonstrating a reduced need for vasopressors dose and better hemodynamic stability. However, human studies were either uncontrolled or retrospective, thereby limiting the inference that could be drawn [21].…”

Defining Acute Renal Failure

“…Most of the still uncontrolled and preliminary studies describing this dialysis modality only use outcomes on "crude mortality" and surrogate end points, such as need for vasopressors (47,48). One retrospective study (49) compared two groups of oliguric septic patients (before and after introduction of early short-term isovolemic hemofiltration). Group 1 received conventional extracorporeal support, and group 2 received hemofiltration at 45 ml/kg per h over 6 h, followed by conventional continuous venovenous hemofiltration.…”

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

“…Survival at 28 days was the same in both groups.  One retrospective study evaluated the effects of isovolemic hemofiltration on physiological and clinical outcomes in 80 patients with septic shock and oliguric acute kidney injury (31). Prior to 1999, 40 patients had received conventional supportive therapy; subsequently, 40 patients received hemofiltration at 45 mL/kg per hour over the first six hours, which was followed by conventional CVVH.…”