High-Dose Versus Conventional-Dose Continuous Venovenous Hemodiafiltration and Patient and Kidney Survival and Cytokine Removal in Sepsis-Associated Acute Kidney Injury: A Randomized Controlled Trial

Park, Sun-Hee; Lee, Hajeong; Kee, Youn Kyung; Park, Seokwoo; Oh, Hyung Jung; Han, Seung Hyeok; Joo, Kwon Wook; Lim, Changjin; Kang, Shin Wook; Yoo, Tae‐Hyun; Kim, Yon Su; Jo, Hyung Ah; Han, Miyeun; Lee, Sunhwa; Kim, Eun Young; Yang, Jisoo; Lee, Mi Jung; Kwon, Young Eun; Park, Kyoung Sook; Han, Seung Gyu; Han, In Mee; Yoon, Chang Yun; Ryu, Geun Woo; Jhee, Jong Hyun; Kim, Hyung Woo; Park, Seohyun; Jung, Seonghoon; Kim, Eun Kyoung; Kim, Min Hee; Kim, Yeon Ji; Jang, Yoon Hee; Kim, Mi Rae; Song, Kwnag Ju; Kim, Mi Ae; Hyun, Ju; Choi, Byeol Na

doi:10.1053/j.ajkd.2016.02.049

Cited by 86 publications

(61 citation statements)

References 38 publications

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“…First, the development and validation cohorts were each collected in a single centre. Second, the information on the CRRT prescription such as dose, blood flow rate, and removal rate was not included in the models, but these parameters were not associated with mortality risk in the present cohort (data not shown) and previous studies have also reported that they are not significant . Third, we did not consider long‐term mortality, because the overall mortality rates were already significantly high in the 7‐day timeframe.…”

Section: Discussionmentioning

confidence: 99%

Development of a new mortality scoring system for acute kidney injury with continuous renal replacement therapy

et al. 2019

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Aim On the basis of the worst outcomes of patients undergoing continuous renal replacement therapy (CRRT) in intensive care unit, previously developed mortality prediction model, Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) and the Sequential Organ Failure Assessment (SOFA) needs to be modified. Methods A total of 828 patients who underwent CRRT were recruited. Mortality prediction model was developed for the prediction of death within 7 days after starting the CRRT. Based on regression analysis, modified scores were assigned to each variable which were originally used in the APACHE II and SOFA scoring models. Additionally, a new abbreviated Mortality Scoring system for AKI with CRRT (MOSAIC) was developed after stepwise selection analysis. Results We used all the variables included in the APACHE II and SOFA scoring models. The prediction powers indicated by C‐statistics were 0.686 and 0.683 for 7‐day mortality by the APACHE II and SOFA systems, respectively. After modification of these models, the prediction powers increased up to 0.752 for the APACHE II and 0.724 for the SOFA systems. Using multivariate analysis, seven significant variables were selected in the MOSAIC model wherein its C‐statistic value was 0.772. These models also showed good performance with 0.720, 0.734 and 0.773 of C‐statistics in the modified APACHE II, modified SOFA and MOSAIC scoring models in the external validation cohort (n = 497). Conclusion The modified APACHE II/SOFA and newly developed MOSAIC models could be more useful tool for predicting mortality for patients receiving CRRT.

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Section: Discussionmentioning

confidence: 99%

Development of a new mortality scoring system for acute kidney injury with continuous renal replacement therapy

et al. 2019

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“…193194195196 Much of the dosing guidelines stem from two large scale multicenter randomized controlled trials; however, these two trials were not exclusively done in the setting of SA-AKI. The Veterans Administration-NIH Acute Renal Failure Trial Network enrolled 1055 patients, 579 (54.9%) of whom had sepsis; the Randomized Evaluation of Normal versus Augmented Level (RENAL) Replacement Therapy Trial studied 1465 patients, 723 (49.3%) of whom had severe sepsis.…”

Section: Renal Replacement Therapymentioning

confidence: 99%

Sepsis associated acute kidney injury

Poston

Koyner

2019

BMJ

443

381

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Sepsis is defined as organ dysfunction resulting from the host’s deleterious response to infection. One of the most common organs affected is the kidneys, resulting in sepsis associated acute kidney injury (SA-AKI) that contributes to the morbidity and mortality of sepsis. A growing body of knowledge has illuminated the clinical risk factors, pathobiology, response to treatment, and elements of renal recovery that have advanced our ability to prevent, detect, and treat SA-AKI. Despite these advances, SA-AKI remains an important concern and clinical burden, and further study is needed to reduce the acute and chronic consequences. This review summarizes the relevant evidence, with a focus on the risk factors, early recognition and diagnosis, treatment, and long term consequences of SA-AKI. In addition to literature pertaining to SA-AKI specifically, pertinent sepsis and acute kidney injury literature relevant to SA-AKI was included.

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“…The effect of cytokine removal by blood purification has been investigated using the interventions of extremely high volume hemofiltration (HVHF) for enhanced convective clearance, and high cut-off (HCO) membranes for enhanced diffusive clearance. Randomized controlled trials of HVHF show decreases in cytokine levels but no mortality benefit [2,3]. There is preliminary experience with HCO membranes, with reported improvements of hemodynamic parameters and oxygenation [4].…”

Section: Introductionmentioning

confidence: 99%

Associations of Polyethylenimine-Coated AN69ST Membrane in Continuous Renal Replacement Therapy with the Intensive Care Outcomes: Observations from a Claims Database from Japan

Doi

Iwagami

Yoshida³

et al. 2017

Blood Purif

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Background/Aims: Polyethylenimine-coated polyacrylonitrile (AN69ST) membrane is expected to improve the outcomes of critically ill patients treated by continuous renal replacement therapy (CRRT). Methods: Using a Japanese health insurance claim database, we identified adult patients receiving CRRT in intensive care units (ICUs) from April 2014 to October 2015. We used a multivariable logistic regression model to assess in-hospital mortality and Fine and Gray's proportional subhazards model to assess the ICU length of stay (ICU-LOS) accounting for the competing risks. Results: Of 2,469 ICU patients, 156 were treated by AN69ST membrane. Crude in-hospital mortality was 50.0% in the AN69ST group and 54.0% in the non-AN69ST group. Adjusted odds ratio (OR) of AN69ST membrane use for in-hospital mortality was 0.65 (95% CI 0.45-0.93). The use of AN69ST membrane was also independently associated with shorter ICU-LOS. Conclusion: This retrospective observational study suggested that CRRT with AN69ST membrane might be associated with better in-hospital outcomes.

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High-Dose Versus Conventional-Dose Continuous Venovenous Hemodiafiltration and Patient and Kidney Survival and Cytokine Removal in Sepsis-Associated Acute Kidney Injury: A Randomized Controlled Trial

Cited by 86 publications

References 38 publications

Development of a new mortality scoring system for acute kidney injury with continuous renal replacement therapy

Development of a new mortality scoring system for acute kidney injury with continuous renal replacement therapy

Sepsis associated acute kidney injury

Associations of Polyethylenimine-Coated AN69ST Membrane in Continuous Renal Replacement Therapy with the Intensive Care Outcomes: Observations from a Claims Database from Japan

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