Use of high-volume haemodiafiltration in patients with refractory septic shock and acute kidney injury

BACKGROUND: High-volume haemofiltration (HVHF) has been used successfully in animal models with sepsis, and preliminary data have shown that this technique may improve the haemodynamics in patients with refractory septic shock. We used high-volume continuous venovenous haemodiafiltration (CVVHDF) in patients with acute kidney injury (AKI) and refractory septic shock to evaluate their outcome when compared with their prognosis predicted by scores of severity. METHODS: This is a cohort study in a Medical and Surgical Intensive Care Unit. Fifty-five patients with refractory septic shock and AKI were included in the study. RESULTS: High-volume CVVHDF was started in patients with AKI and septic shock requiring norepinephrine dose >0.2 µg/kg/min. AKI was classified according to the RIFLE criteria. Treatment was implemented within the first 24 h of refractory septic shock with a dialysis dose of 70 mL/kg/h until reversal of shock or death. Fifty-five patients were treated with high-volume CVVHDF with an observed mortality of 63%, similar to the mortality predicted by the APACHE II and SAPS II scores. CONCLUSION: Survival rate in our patients with AKI and refractory septic shock treated with high-volume CVVHDF was identical to survival predicted by the severity scores. Treatment with high-volume haemodiafiltraton is applicable to severely ill patients with septic shock but does not confer any clear advantage in terms of survival. This therapy should not be implemented on a routine basis in patients with AKI and refractory septic shock.