Continuous Veno-Venous High Cut-Off Hemodialysis Compared to Continuous Veno-Venous Hemodiafiltration in Intensive Care Unit Acute Kidney Injury Patients

Abstract

Aims: High cut-off (HCO) continuous veno-venous hemodialysis (CVVHD) was compared to high-flux membrane (HFM) continuous veno-venous hemodiafiltration (CVVHDF) in intensive care unit (ICU) acute kidney injury (AKI) in terms of efficiency, hemodynamic tolerance, medium-sized molecules removal, albumin loss, and inflammatory system activation.

Methods: In a prospective cross-over randomized study, 10 AKI patients underwent successively HCO (Ultraflux EmiC2: β2-microglobulin [β2M] sieving coefficient [SC]: 0.9) CVVHD and HFM (Ultraflux AV1000S: β2M SC: 0.65) -CVVHDF.

Results: Over the 20 sessions, hypotensive and febrile episodes, reduction rates of urea, creatinine, and β2M were similar in both modalities. Though dialysis dose was higher with CVVHDF (36 ± 4 vs. 21 ± 6 mL/Kg/h), urea, creatinine, and β2M instantaneous and plasmatic clearances did not differ except for urea at 12 h. Protein loss, superoxide anion production, cytokines, and growth factors variations were also comparable.

Conclusion: HCO CVVHD is well tolerated and is as effective as HFM CVVHDF in clearance of solutes and removal of β2M. It induces neither protein loss nor overproduction of superoxide anion. Video Journal Club "Cappuccino with Claudio Ronco" at http://www.karger.com/?doi=489082.

Keywords: Acute kidney injury; Continuous hemodiafiltration; Continuous hemodialysis; Continuous renal replacement therapy; Cytokines; High cut-off membrane; High-flux membrane; Oxidative stress.