Atan
Trial question
What is the role of continuous venovenous hemofiltration-high cutoff in critically ill patients with AKI?
Study design
Single center
Double blinded
RCT
Population
Characteristics of study participants
41.8% female
58.2% male
N = 76
76 patients (31 female, 43 male)
Inclusion criteria: patients in the ICU with AKI who were vasopressor-dependent
Key exclusion criteria: age < 18 years, suspected death within 24 hours by the treating clinician, previous treatment with hemofiltration or another dialysis during the same hospital admission, maintenance dialysis prior to admission or pregnant or breastfeeding
Interventions
N=36 continuous venovenous hemofiltration-high cutoff (polyethersulfone high cutoff filter with nominal cutoff point of 100 kDa)
N=38 continuous venovenous hemofiltration-standard (custom manufactured polyethersulfone standard hemofilter with nominal cutoff point of 30 kDa)
Primary outcome
Norepinephrine-free time over 7 days
32
56
56.0 hours
42.0 hours
28.0 hours
14.0 hours
0.0 hours
Continuous venovenous hemofiltration-high cutoff
Continuous venovenous hemofiltration-standard
No significant difference ↔
No significant difference in norepinephrine-free time over 7 days (32 hours vs. 56 hours; AD -24 hours, 95% CI -95.32 to 47.32)
Secondary outcomes
No significant difference in death in the ICU (50% vs. 31.6%; OR 2.17, 95% CI 0.84 to 5.58)
No significant difference in death in the hospital (55.6% vs. 34.2%; OR 2.4, 95% CI 0.94 to 6.15)
No significant difference in dose of intravenous albumin given over the first 7 days (90 grams vs. 80 grams; AD 10 grams, 95% CI -6.94 to 26.94)
Safety outcomes
No significant differences in time to cessation of norepinephrine, time to cessation of hemofiltration, filter life, serum albumin levels, time to death.
Conclusion
In patients in the ICU with AKI who were vasopressor-dependent, continuous venovenous hemofiltration-high cutoff was not superior to continuous venovenous hemofiltration-standard with respect to a norepinephrine-free time over 7 days.
Reference
Rafidah Atan, Leah Peck, John Prowle et al. A Double-Blind Randomized Controlled Trial of High Cutoff Versus Standard Hemofiltration in Critically Ill Patients With Acute Kidney Injury. Crit Care Med. 2018 Oct;46(10):e988-e994.
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