Clinical Assessment of Continuous Hemodialysis with the Medium Cutoff EMiC < b > ® < /b > 2 Membrane in Patients with Septic Shock

In this study, medium cutoff (MCO) continuous venovenous hemodialysis (CVVHD) was compared to high-flux membrane continuous venovenous hemodiafiltration (CVVHDF) in terms of hemodynamic improvement, efficiency, middle molecule removal, and inflammatory system activation.Methods: This is a monocenter crossover randomized study. Between December 31, 2017, and December 31, 2019, 20 patients with septic shock and stage 3 acute kidney injury (AKI) admitted to 2 Italian ICUs were enrolled. All patients underwent CVVHD with Ultraflux ® EMiC®2 and CVVHDF with AV1000S® without washout. Each treatment lasted 24 h.Results: Compared to AV1000S ®-CVVHDF, EMIC®2-CVVHD normalized cardiac index (β = −0.64;p = 0.02) and heart rate ( β = 5.72;p = 0.01). Interleukin-8 and myeloperoxidase removal were greater with AV1000S ®-CVVHDF than with EMiC®2-CVVHD (β = 0.35;p #x3c; 0.001; β = 0.43;p = 0.03, respectively). Leukocytosis improved over 24 h in EMiC ®2-CVVHD-treated patients (β = 4.13;p = 0.03), whereas procalcitonin levels decreased regardless of the modality ( β = 0.89;p = 0.01) over a 48-h treatment period. Reduction rates, instantaneous plasmatic clearance of urea, creatinine, and β2-microglobulin were similar across modalities. β2-Microglobulin removal efficacy was greater in the EMiC®2 group (β = 0–2.88;p = 0.002), while albumin levels did not differ. Albumin was undetectable in the effluent in both treatments.Discussion: In patients with septic shock and severe AKI,...
Source: Blood Purification - Category: Hematology Source Type: research