A Retrospective Study on the Start and End of Continuous Hemodialysis Using a Polymethylmethacrylate Hemofilter for Severe Acute Pancreatitis

Abstract

Objective We previously reported the successful outcomes in severe acute pancreatitis (SAP) after continuous hemodialysis using a polymethylmethacrylate hemofilter (PMMA-CHD). The present study makes informative suggestions regarding the initiation and termination of PMMA-CHD. Methods We retrospectively studied 63 patients with SAP admitted to the intensive care unit between January 1, 2011, and December 31, 2022, including 30 who received PMMA-CHD therapy for renal dysfunction. Statistical significance was evaluated using a multiple logistic regression analysis for severity scores, prognostic factor scores in the Japanese severity criteria, the Kidney Disease: Improving Global Outcomes (KDIGO) stage, and the lung injury score (LIS). Results At the onset of blood purification therapy using PMMA-CHD, a significant increase in the KDIGO stage was shown, with a cutoff value of 2.0. The prognostic factor score and LIS at the start of blood purification therapy were significantly high, with a cutoff value of 3.0. Analyses of severity scores, the KDIGO stage, and the LIS before the start of PMMA-CHD were also increased significantly, with cutoff values of +2.0, +1.0, and +3.0, respectively. Furthermore, on analyses of improvements in values after starting PMMA-CHD, the value of KDIGO staging significantly decreased, and the cutoff value was -2.0. The prognostic factor score was also significantly decreased, with a cutoff value of -2.0. Conclusion Prognostic factor scores of the Japanese severity criteria and LIS, as well as the KDIGO stage, are valuable indicators for determining the start and end of PMMA-CHD therapy.

Keywords: Japanese prognostic factor; acute kidney injury; continuous hemodialysis; lung injury; polymethylmethacrylate hemofilter; severe acute pancreatitis.

Figure.

Changes in the APACHE II score, SOFA score, prognostic factor score of the Japanese severity criteria, KDIGO stage, and LIS during ICU care. For patients who did not require PMMA-CHD therapy, the values at the start of PMMA-CHD were denoted by the values on the day after ICU admission, and the values at the end of PMMA-CHD were denoted by the values at the end of ICU care. Red boxes: PMMA-CHD group (n=30); blue boxes: non-CHD group (n=33). Boxes: 25-75th percentiles. Error bars indicate 10th and 90th percentiles. Bold horizontal lines indicate medians, and closed squares indicate mean values. Open circles represent outliers. Statistical significance within each group was evaluated using multiple comparisons (Bonferroni-Dunn test): (a) p<0.05, compared with the initial value at hospitalization; and (b) p<0.05, compared with the second value at the start of PMMA-CHD. APACHE: Acute Physiology and Chronic Health Evaluation, SOFA: Sequential Organ Failure Assessment, KDIGO: Kidney Disease: Improving Global Outcome, LIS: lung injury score