High-volume hemofiltration in adult burn patients with septic shock and acute kidney injury: a multicenter randomized controlled trial

Chung, Kevin K.; Coates, Elsa C; Smith, David J.; Karlnoski, Rachel; Hickerson, William L.; Arnold-Ross, Angela L.; Mosier, Michael J.; Halerz, Marcia; Sprague, Amy; Mullins, Robert F.; Caruso, Daniel M.; Albrecht, Marlene; Arnoldo, Brett D.; Burris, Agnes; Taylor, Sandra L.; Wolf, Steven E.

doi:10.1186/s13054-017-1878-8

Cited by 71 publications

(66 citation statements)

References 42 publications

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“…Furthermore, we have found previously that CVVH is well tolerated in this population and may even be therapeutic in the form of shock reversal based on a recent randomized controlled trial. 8 , 13 …”

Section: Discussionmentioning

confidence: 99%

Renal Replacement Therapy in Severe Burns: A Multicenter Observational Study

Chung

Coates

Hickerson

et al. 2018

Journal of Burn Care &Amp; Research

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Acute kidney injury (AKI) after severe burns is historically associated with a high mortality. Over the past two decades, various modes of renal replacement therapy (RRT) have been used in this population. The purpose of this multicenter study was to evaluate demographic, treatment, and outcomes data among severe burn patients treated with RRT collectively at various burn centers around the United States. After institutional review board approval, a multicenter observational study was conducted. All adult patients aged 18 or older, admitted with severe burns who were placed on RRT for acute indications but not randomized into a concurrently enrolling interventional trial, were included. Across eight participating burn centers, 171 subjects were enrolled during a 4-year period. Complete data were available in 170 subjects with a mean age of 51 ± 17, percent total body surface area burn of 38 ± 26% and injury severity score of 27 ± 21. Eighty percent of subjects were male and 34% were diagnosed with smoke inhalation injury. The preferred mode of therapy was continuous venovenous hemofiltration at a mean delivered dose of 37 ± 19 (ml/kg/hour) and a treatment duration of 13 ± 24 days. Overall, in hospital, mortality was 50%. Among survivors, 21% required RRT on discharge from the hospital while 9% continued to require RRT 6 months after discharge. This is the first multicenter cohort of burn patients who underwent RRT reported to date. Overall mortality is comparable to other critically ill populations who undergo RRT. Most patients who survive to discharge eventually recover renal function.

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Section: Discussionmentioning

confidence: 99%

Renal Replacement Therapy in Severe Burns: A Multicenter Observational Study

Chung

Coates

Hickerson

et al. 2018

Journal of Burn Care &Amp; Research

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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

483

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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“…A recent study found an odds of dialysis of 2.40 in burn patients who developed AKI compared with the general Finnish population (71). Eleven studies followed up the long-term renal outcomes of burn patients who survived RRT (9,18,19,21,27,30,34,36,37,50,54). A total of 184 patients survived after renal replacement therapy; 64.13% of them (118/184) were dialysis-independent after discharge, 25% (46/184) needed temporary required dialysis, and 10.87% (20/184) needed long-term dialysis (more than 6 months after discharge).…”

Section: Renal Outcomementioning

confidence: 99%

“…Chung 2017 conducted a multicentre, prospective, randomized, controlled clinical trial to evaluate the impact of high-volume haemo ltration (HVHF) on the haemodynamic pro le of burn patients with septic shock and AKI. They concluded that HVHF was effective in reversing shock and improving organ function in burn patients with septic shock and AKI, but the data were insu cient to comment on improving survival (9). Another random prospective study concluded that HVHF conducted in the early stage (within 3 days) could reduce the incidence of sepsis and the mortality of patients with severe burns (10).…”

Section: Introductionmentioning

confidence: 99%

Renal Replacement Therapy for Burn Patients: A Systematic Review and Meta-Analysis

Duan¹,

Chen²,

Cai³

et al. 2020

Preprint

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Background: To improve the prognosis of burn patients with renal replacement therapy (RRT), we performed this systematic review and meta-analysis.Methods: We searched multiple databases for studies published before February 2020. Studies about adult populations with burn injury, providing epidemiologic data on prevalence or mortality of RRT, were included. Results: A total of selected 58 studies, including 38,787 patients were enrolled in our analysis. The prevalence rates of RRT were 5.14% (95%CI 4.54%-5.74%) in all burn patients and 35.8% (95%CI 29.54%-42.07%) in acute kidney injury (AKI) patients. The prevalence of RRT among burn patients in the intensive care unit (ICU) was 10.92% (95%CI 8.71%-13.14%). The mortality of all burn patients with RRT was 65.52% (95%CI 58.41%-72.64%). The mortality of patients with RRT in ICU was 62.7% (95%CI 53.7%-71.7%). The mortality rate of RRT patients was 30.33% (95%CI 22.06%-38.59%) of the total. There was no significant correlation (r=-0.224, P=0.159) between the year of publication and the mortality of burn patients with RRT. Neither cohort studies nor RCT studies of subgroup analyses show that RRT could reduce the risk of death in burn patients with AKI. Bleeding (10.92%) and secondary infection (9.61%) were the most common RRT-related adverse reactions. Compared with heparin, regional citrate anticoagulation has advantages in superior filter life spans and fewer bleeding episodes. Dialysis-requiring AKI in burn patients could increases the risk of chronic kidney disease progression and end-stage renal disease. About 35% of RRT patients need to maintain hemodialysis temporarily, even if they survive and leave hospital. Conclusions: The prevalence of RRT is not low; approximately, one-third of burn patients with AKI need RRT. The mortality of burn patients with RRT is very high and accounts for 1/3 of the total deaths. There is no evidence that RRT can improve the prognosis of burn patients with AKI. Regional citrate anticoagulation has some advantages in reducing bleeding and extending filter life spans, which may be more suitable for severe burn patients with CRRT.

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High-volume hemofiltration in adult burn patients with septic shock and acute kidney injury: a multicenter randomized controlled trial

Cited by 71 publications

References 42 publications

Renal Replacement Therapy in Severe Burns: A Multicenter Observational Study

Renal Replacement Therapy in Severe Burns: A Multicenter Observational Study

Sepsis associated acute kidney injury

Renal Replacement Therapy for Burn Patients: A Systematic Review and Meta-Analysis

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