Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Am J Kidney Dis. 2016 Oct;68(4):599-608. doi: 10.1053/j.ajkd.2016.02.049. Epub 2016 Apr 12.
Soluble inflammatory mediators are known to exacerbate sepsis-induced acute kidney injury (AKI). Continuous renal replacement therapy (CRRT) has been suggested to play a part in immunomodulation by cytokine removal. However, the effect of continuous venovenous hemodiafiltration (CVVHDF) dose on inflammatory cytokine removal and its influence on patient outcomes are not yet clear.
Prospective, randomized, controlled, open-label trial.
SETTING & PARTICIPANTS: Septic patients with AKI receiving CVVHDF for AKI.
Conventional (40mL/kg/h) and high (80mL/kg/h) doses of CVVHDF for the duration of CRRT.
Patient and kidney survival at 28 and 90 days, circulating cytokine levels.
212 patients were randomly assigned into 2 groups. Mean age was 62.1 years, and 138 (65.1%) were men. Mean intervention durations were 5.4 and 6.2 days for the conventional- and high-dose groups, respectively. There were no differences in 28-day mortality (HR, 1.02; 95% CI, 0.73-1.43; P=0.9) or 28-day kidney survival (HR, 0.96; 95% CI, 0.48-1.93; P=0.9) between groups. High-dose CVVHDF, but not the conventional dose, significantly reduced interleukin 6 (IL-6), IL-8, IL-1b, and IL-10 levels. There were no differences in the development of electrolyte disturbances between the conventional- and high-dose groups.
Small sample size. Only the predilution CVVHDF method was used and initiation criteria were not controlled.
High CVVHDF dose did not improve patient outcomes despite its significant influence on inflammatory cytokine removal. CRRT-induced immunomodulation may not be sufficient to influence clinical end points.
已知可溶性炎症介质可加重脓毒症引起的急性肾损伤（AKI）。连续肾脏替代疗法（CRRT）通过细胞因子清除被认为在免疫调节中发挥作用。然而，连续静脉-静脉血液透析滤过（CVVHDF）剂量对炎症细胞因子清除的影响及其对患者结局的影响尚不清楚。
前瞻性、随机、对照、开放标签试验。
接受 CVVHDF 治疗 AKI 的 AKI 脓毒症患者。
CRRT 期间给予常规（40mL/kg/h）和高（80mL/kg/h）剂量的 CVVHDF。
28 天和 90 天的患者和肾脏存活率，循环细胞因子水平。
212 名患者被随机分为 2 组。平均年龄为 62.1 岁，138 名（65.1%）为男性。常规剂量组和高剂量组的平均干预时间分别为 5.4 和 6.2 天。两组 28 天死亡率（HR，1.02；95%CI，0.73-1.43；P=0.9）或 28 天肾脏存活率（HR，0.96；95%CI，0.48-1.93；P=0.9）无差异。高剂量 CVVHDF 可显著降低白细胞介素 6（IL-6）、白细胞介素 8（IL-8）、白细胞介素 1b（IL-1b）和白细胞介素 10（IL-10）水平，但常规剂量则不然。常规剂量组和高剂量组之间电解质紊乱的发展无差异。
样本量小。仅使用了预稀释 CVVHDF 方法，且未控制起始标准。
尽管高 CVVHDF 剂量对炎症细胞因子清除有显著影响，但并未改善患者结局。CRRT 诱导的免疫调节可能不足以影响临床终点。
