Hemodialysis with High Cut-Off Hemodialyzers in Patients with Multi-Drug Resistant Gram-Negative Sepsis and Acute Kidney Injury: A Retrospective, Case-Control Study

Abstract

Background: Hemodialysis with high cut-off continuous veno-venous hemodialyzer (HCO-CVVHD) removes mediators of organ dysfunction during sepsis. This study assessed the clinical effects of HCO-CVVHD as compared to high-flux (HF) membranes during gram-negative sepsis. Methods: Intensive care unit (ICU), septic patients treated with HCO-CVVHD or HF-CVVHDF for AKI were retrospectively observed (January 2013-December 2014). Mechanical ventilation, vasopressors' requirements, ICU length of stay (LOS) and ICU in-hospital mortality were compared between groups. Results: Sixteen HCO and 8 HF patients were observed. Isolated pathogens included Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli and Pseudomonas aeruginosa. Median ratios of days-on-vasopressors and days-on-mechanical ventilation/ICU-LOS were 0.5, 1 and 0.8, 1 for HCO and HF groups (p < 0.03), respectively. ICU-LOS was 16 and 9 days (HCO- and HF-group, p = 0.03). ICU mortality rates were 37.5 and 87.5% for HCO and HF groups, respectively (p = 0.03). No statistical difference was found in in-hospital morality. Conclusion: Patients in HCO-CVVHD group spent lesser number of days on vasopressors and mechanical ventilation as a ratio to total ICU-LOS. In the same group, a reduction in ICU mortality was observed.

Super High‐Flux Continuous Venovenous Hemodialysis Using Regional Citrate Anticoagulation: Long‐Term Stability of Middle Molecule Clearance

“…A small study by Morgera et al showed a reduction in serum‐levels of proinflammatory cytokines in septic patients and a reduced need for catecholamines . A retrospective analysis in sepsis patients showed a reduced need for vasoactive drugs and mechanical ventilation as well as improved short‐term survival . However, none of the studies thoroughly investigated prospectively the filter characteristics in detail and for the whole treatment period.…”

Extracorporeal Blood Purification Therapies for Sepsis

“…However, these membranes are currently used with diffusive methods or after optimization of their architecture to limit albumin losses while preserving their capacity to remove middle molecular weight molecules [35,36]. Observational studies including patients with septic shock treated with high cutoff membranes and diffusive CRRT found an effective removal of cytokines and a reduction of intensive care unit length of stay and mortality [37][38][39].…”

Extracorporeal techniques for the treatment of critically ill patients with sepsis beyond conventional blood purification therapy: the promises and the pitfalls

“…Overall, the studies are suggestive of a decrease in inflammatory cytokines and improvement of hemodynamics, along with an improvement in ICU patient severity of illness scores as reported by Morgera et al [ 27 – 30 ]. One study comparing continuous veno-venous hemodialysis with HCO membranes (HCO-CVVHD; at a dose of 35 ml/kg/h) vs CVVHDF (at a dose of 45 ml/kg/h) showed an ICU mortality benefit (37.5 and 87.5% for HCO-CVVHD and CVVHDF groups, respectively ( p = 0.03)), but no significant difference was found in ICU-LOS and in-hospital mortality [ 32 ]. Furthermore, the High Cut-Off Sepsis study (HICOSS) comparing conventional and HCO membranes was stopped prematurely after enrolment of 81 patients due to a lack of 28-day mortality benefit (HCO (31%) vs conventional (33%)) and lack of a difference in vasopressor requirement or ICU-LOS [ 35 ].…”