Effect of the intensity of continuous renal replacement therapy in patients with sepsis and acute kidney injury: a single-center randomized clinical trial.

摘要

Acute kidney injury (AKI) is a major complication in patients with sepsis and is an independent predictor of mortality. However, the optimal intensity of renal replacement therapy for such patients is still controversial.From 1 January 2004 to 30 September 2009, we randomly assigned 280 patients with sepsis and AKI to continuous renal replacement therapy by high-volume hemofiltration (50 mL/kg/h, HVHF) or extra high-volume hemofiltration (85 mL/kg/h, EHVHF). The primary study outcome was death from any cause within 28, 60 and 90 days. Results were analyzed by univariate and multivariate methods and by Kaplan-Meier survival curves.A total of 141 patients were given EHVHF and 139 were given HVHF. The two groups had similar baseline characteristics and received treatment for an average of 9.38 days (EHVHF group) and 8.88 days (HVHF group). There were no significant differences between the groups in number of deaths at 28, 60 or 90 days. There were also no differences between the groups in renal outcome of survivors at 90 days. Multivariate analysis indicated that inotropic support by norepinephrine, time in hospital of >7 days, blood platelet count <8 × 10(9)/L, Acute Physiological and Chronic Health Evaluation (APACHE) II score >25, total bilirubin >100 μmol/L, prothrombin time >18 s, serum creatinine <250 μmol/L and blood urea nitrogen >20 mmol/L were independent risk factors for death at 90 days after initiation of renal replacement therapy.In patients with sepsis and AKI, increasing the intensity of renal replacement therapy from 50 (HVHF) to 85 mL/kg/h (EHVHF) had no effect on survival at 28 and 90 days.