Effect of early and intensive continuous venovenous hemofiltration on patients with cardiogenic shock and acute kidney injury after cardiac surgery

Abstract

Objective: Continuous renal replacement therapy (CRRT) is currently the mainstay renal support for critically ill patients. However, the optimal intensity of CRRT remains debated owing to the heterogeneity of the study populations and CRRT techniques across centers. The present study investigated the beneficial effects of early and intensive continuous venovenous hemofiltration (CVVH) on patients with shock after cardiotomy.

Methods: Patients who had received CRRT for cardiogenic shock and acute kidney injury after cardiac surgery from January 2003 to December 2007 were retrospectively recruited. They were divided into 2 groups according to the delivered dosage of hemofiltration.

Results: The mean duration between intensive care unit admission and initiation of CVVH was 1.4±0.8 days. The all-cause mortality by day 30 was 73.3% and 45.4% in the low- and high-dose groups, respectively (P=.002). The corresponding in-hospital mortality rate was 82.2% and 61.8% (P=.02). No significant difference was seen in the renal recovery of the survivors between the 2 groups.

Conclusions: In patients developing postoperative cardiogenic shock and acute kidney injury after cardiac surgery, an early higher CVVH dose was associated with better in-hospital and long-term survival. Moreover, the beneficial effect of intensive treatment might be more critical in the early perioperative period.