KfH Kidney Centre, Berlin-Köpenick, Germany.
Nephrol Dial Transplant. 2012 Jan;27(1):146-52. doi: 10.1093/ndt/gfr269. Epub 2011 May 28.
The outcome of patients with septic multiple organ failure (MOF) remains poor. There are experimental and clinical data indicating a beneficial effect of high-volume haemofiltration. Delivering high-volume therapy is only cost effective using on-line devices because of high costs for additional solution bags in conventional continuous renal replacement therapy (CRRT). We investigated feasibility and effectiveness of extended daily on-line high-volume haemodiafiltration (HDF) with technically maximum convective volume in patients with septic MOF in a pilot study.
We included 21 consecutive critically ill patients with septic MOF having a mortality risk >50% (SAPS II >50, APACHE II >25). Renal replacement therapy (RRT) was applied with extended daily HDF for 6-23 h using the AK 200 Ultra S dialysis machine in the ultracontrol pre-dilution mode. Dialysate and substitution fluid were prepared on-line. Patients underwent 289 treatments.
The mean convective volume was 17.8 ± 3.7 L/h and 208 ± 66 mL/kg/h, respectively, median treatment time was 10:15 h/day. Seventeen of 21 patients survived 28 days (81%). The 90-day survival rate was 52% (11/21) versus 19% compared to the survival rate predicted by APACHE II (33.6 mean) and SAPS II (68.6 mean) scores. Haemodynamics improved significantly during the treatment procedures. Material costs per treatment amounted to 35 €.
Extended daily on-line HDF using maximum convective volume seems to improve the outcome of septic MOF, especially in the early phase. The investigated mode of treatment proved to be feasible, well tolerated and highly cost effective compared to conventional CRRT. At present, this procedure would be applicable at every ICU facility with nephrological support.
脓毒症伴多发器官衰竭（MOF）患者的预后仍然较差。有实验和临床数据表明，大剂量血液滤过治疗有益。由于传统连续性肾脏替代治疗（CRRT）中额外溶液袋的成本较高，只有使用在线设备提供大容量治疗才具有成本效益。我们在一项试点研究中调查了在脓毒症 MOF 患者中进行扩展每日在线大容量血液透析滤过（HDF）治疗的可行性和有效性，该治疗采用技术上最大的对流体积。
我们纳入了 21 例连续的患有脓毒症 MOF 且死亡率风险>50%（SAPS II>50，APACHE II>25）的危重症患者。使用 AK 200 Ultra S 透析机在超控预稀释模式下进行肾替代治疗（RRT），采用扩展每日 HDF 治疗 6-23 小时。在线制备透析液和替代液。患者共接受了 289 次治疗。
平均对流体积分别为 17.8±3.7 L/h 和 208±66 mL/kg/h，中位治疗时间为 10:15 h/天。21 例患者中有 17 例（81%）存活 28 天。90 天存活率为 52%（11/21），与 APACHE II（33.6 平均）和 SAPS II（68.6 平均）评分预测的存活率相比，分别提高了 19%和 19%。在治疗过程中，血液动力学显著改善。每次治疗的材料成本为 35 欧元。
使用最大对流体积的扩展每日在线 HDF 似乎可以改善脓毒症 MOF 的预后，尤其是在早期阶段。与传统 CRRT 相比，该治疗模式具有可行性、良好的耐受性和较高的成本效益。目前，这种治疗方案适用于具有肾脏支持的每个 ICU 病房。
