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Hemoperfusion plus continuous veno-venous hemofiltration for patients with sepsis and acute kidney injury

TANG Yi,ZHANG Ling,YANG Ying-ying(Department of Nephrology,West China Hospital,Sichuan University,Chengdu 610041)  
Objective To evaluate the therapeutic effect of continuous veno-venous hemofiltration(CVVH) plus hemoperfusion(HP) for patients with sepsis and acute kidney injury(AKI).Methods We prospectively enrolled patients with sepsis and AKI admitted in our hospital between July 2010 and October 2011.Patients were randomly assigned to CVVH plus HP group(study group) or CVVH group(control group) when confirmed to meet the inclusion criteria.Patients in study group received HP treatment 2 hours a time every 24 hours with hemoperfutor installed after the hemofilter,and HP were performed at least 3 times for each patient.CVVH treatment was performed continuously in both groups and adjusted according to patients' clinical conditions 3 days after inclusion.Other conventional treatments were given by clinical guideline for sepsis.Blood samples of all patients were withdrawed at the beginning of treatment(0h) and at 72h to test the plasma level of TNF-α,IL-1,IL-6,IL-10.Vital signs and other laboratory tests were recorded.60-day survival rate,duration of ICU stay and time needed for renal recovery were evaluated.Results 25 patients were enrolled,with 14 patients in study group and 11 patients in control group.60-day survival rate was 6/14(42.9% in study group and 4/11(36.4%)in control group respectively,no significant difference was found between two groups.For survivors,duration of ICU stay had no significant difference between groups(18.8±10.5d vs.28.8±10.2d,P=0.392).Time needed for renal recovery for survivors in study group was 7.4±5.4d,which is significantly shorter than that of control group(25.5±15.7d,P=0.019).Plasma level of TNF-α,IL-1,IL-6 and IL-10 at 0h had no significant difference between groups.At 72h,plasma level of TNF-αand IL-1 decreased significantly in study group and IL-1 level of control group also showed significant decrease.No reverse effect was found in both groups.Conclusion Compared with CVVH solely,CVVH plus HP may be more effective to remove plasma inflammatory factors and could reduce the time needed for renal recovery for patients with sepsis and AKI.
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