Background: Early goal-directed therapy (EGDT) has been shown to improve patient outcomes. Treatment of patients unresponsive to the protocol, however, is difficult and the result is occasionally fatal. Recently, continuous renal replacement therapy (CRRT) has been used to treat acute kidney injury (AKI) to improve survival. We examined the effectiveness of CRRT in treating septic shock patients with concurrent AKI who are not amenable to EGDT.
Methods: We studied 17 patients who underwent emergency surgery for intra-abdominal infection; these patients experienced AKI complications and did not respond to EGDT within 6 hrs after intensive care unit (ICU) admission. We treated patients with continuous venovenous hemodiafiltration (CVVHDF; dialysis = 900 ml/hr, filtration = 900 ml/hr, total hemopurification = 1800 ml/hr). We measured mean arterial pressure (MAP), central venous pressure (CVP), central venous oxygen saturation (ScvO2), catecholamine index (CAI), and determined serum concentrations of lactate, interleukin-6 (IL-6), and high mobility group box-1 protein (HMGB-1) immediately before and 3, 6, 12, 24, 48 hrs after CRRT initiation. We also evaluated 28-day survival, ICU survival, and hospital survival.
Results: CRRT duration was 6.5±4.2 days. MAP and ScvO2 significantly increased with CRRT, while CAI and concentrations of lactate, IL-6, and HMGB-1 significantly decreased. After CRRT, no patients required intermittent hemodialysis in the ICU. Mean ICU stay was 15.1±10.4 days. ICU survival, 28-day survival, and hospital survival were 76.5%, 76.5%, and 70.6%, respectively.
Conclusions: CRRT may be an effective treatment for seriously ill patients who have complications of AKI and are unresponsive to EGDT.