Sun-003 Online Hemodiafiltration (Post-Dilution) as Compared to High Flux Hemodialysis Does Not Improve Outcomes in Community Acquired Aki With sirs- A Randomised Controlled Trial

Abstract

Introduction: Contrast-induced nephropathy (CIN) / Contrast inducedacute kidney injury (CI-AKI) is one of the most common causes of hospital-acquired AKI. Methods: This is a prospective, single center study of 774 consecutive patients (449 males and 325 females with mean age of 48.85 AE 14.05 years) who underwent iodinated contrast procedures with nonionic, low-osmolality iodinated contrast medium (Iomeprol) via IV and IA routes from 2013 to 2015 were included in the study. CIN was defined as a relative increase of $25% or an absolute increase of >0.5 mg/dL in serum creatinine levels within 2 days post-procedure. We recorded the baseline characteristics, laboratory parameters along with underlying renal injury risk factors; contrast administration volume, type, and route of administration; incidence of CIN and requirement of dialysis and use of prophylactic measures for CIN. Univariate and multivariate models were used to determine predictors of CIN. Results: The total incidence of CIN was 14.85% (115 patients) with the incidence being 77.4% following IA contrast administration versus 22.6% following IV contrast administration (p ¼ 0.001). Baseline eGFR was lower for patients undergoing IA contrast procedures (66.02 AE 23.70 ml/min/1.73m 2 vs 71.31AE24.07 ml/min/1.73m 2 , p¼0.002). The total risk of renal replacement therapy was 1.7% (13 patients) with the incidence being more in the IA group than the IV group (3.1% vs

Intermittent Convective Therapies in Patients with Acute Kidney Injury: A Systematic Review with Meta-Analysis

“…In the 4 observational studies, quality varied, where 2 studies can be categorized as low quality [22, 29] and 2 as intermediate quality [1, 24] according to the Newcastle-Ottawa Scale. Overall, the risk of bias of all observational studies [1, 22, 24, 29] and 2 RCTs [23, 28] was high. Allocation concealment was not specified in most studies, which might induce a selection bias toward one modality.…”

“…Dialysis prescription in terms of duration, blood flow rate, and dialysate flow rate varied across all studies, as shown in Table 1. Only one study [28] involved post-dilution HDF, while the remaining consisted of pre-dilution HDF or pre-dilution HF.…”

“…Of these, 3,151 were excluded after screening titles and abstracts. A total of 10 unique studies were eligible after full-text screening [1,[21][22][23][24][25][26][27][28][29], from which 8 studies presented quantitative results for at least one prespecified outcome. The following outcomes were not mentioned in enough articles to allow a meta-analysis: length of stay, Kt/V urea , and intradialytic hypotension.…”

Online Hemodiafiltration Compared to Conventional Hemodialysis in Critically Ill Patients

“…In a recent meta-analysis comparing conventional HD to intermittent convective therapies, 15 we reported that only 3 small scale exploratory trials ever compared HD to HDF. 33 , 34 , 35 Most interestingly, pooling the results of these trials revealed a higher risk of in-hospital death with the use of HDF (Risk ratio: 2.07 CI: 1.04–4.11). 15 Therefore, further investigation was urgently required to determine the safety and potential benefits of HDF in an ICU setting.…”

“…In contrast, the possibility to perform high volume of convective clearance using IRRT is more recent with the development of online HDF. In a recent meta-analysis comparing conventional HD to intermittent convective therapies 15 , we reported that only 3 small scale exploratory trials ever compared HD to HDF [33][34][35] . Most interestingly, pooling the results of these trials revealed a higher risk of in-hospital death with the use of HDF (Risk ratio: 2.07 CI: 1.04-4.11) 15 .…”