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Table 1 The main studies describing the effectiveness/limitations of high volume hemofiltration

From: Extracorporeal techniques for the treatment of critically ill patients with sepsis beyond conventional blood purification therapy: the promises and the pitfalls

 

Honoré et al. 2000 [18]

Cole et al. 2001 [15]

Joannes-Boyau et al. 2004 [12]

Ratanarat et al. 2005 [19]

Cornejo et al. 2006 [14]

Piccinni et al. 2006 [13]

Boussekey et al. 2008 [16]

Joannes-Boyau et al. 2013 [17] (IVOIRE)

Study design

Cohort, uncontrolled prospective

Randomized crossover

Cohort, uncontrolled prospective

Cohort, uncontrolled prospective

Cohort, uncontrolled prospective

Retrospective

Prospective randomized study

Prospective, randomized, open, multicenter

Study population (n)

20 septic shock patients

11 septic shock patients

24 septic shock patients

15 severe sepsis patients

20 septic shock patients

80 septic shock patients

20 septic shock patients and AKI

140 septic shock patients and AKI

Prescribed dose

HVHF (4 h, 35 L of UF removed) followed by conventional CVVH for at least 4 days

8 h of HVHF (6 L/h) or 8 h of standard CVVH (1 L/h)

40–60 ml/kg/h for 96 h

HVHF 85 ml/kg/h for 6–8 h followed by CVVH 35 ml/kg/h for 16–18 h

100 ml/kg/h

Single session of 12 h

HVHF (40 patients) at 45 ml/kg/h over 6 h followed by conventional CVVH compared to 40 historic patients treated with conventional therapy

HVHF 65 ml/(kg h) vs LVHF 35 ml/(kg h)

HVHF at 70 ml/kg/h vs SVHF at 35 ml/kg/h for 96 h

Survival/mortality

28-day observed survival of 45% compared to expected of 21% (p < 0.05)

Hospital mortality 54.5%

28-day mortality of 46% compared to predicted mortality of 70% (p < 0.075)

28-day mortality of 47% compared to predicted mortality of 68–72%

Observed hospital survival of 60% compared to expected survival of 37% (p < 0.03)

28-day survival of 55% compared to 27.5% in the conventional group (p < 0.05)

• ICU mortality of 33.3% in HVHF group vs 60% in LVHF group but not significantly different

• 28-day mortality of 33.3% in the HVHF

• group vs 50% in the LVHF group

• 28 day mortality of 37.9% in HVHF vs 40.8% in SVHF, (p = 0.94)

• No difference in 60 and 90 days mortality

Length of ICU stay

–

–

–

–

–

Significant improvement (p < 0.002)

No difference

No difference

Hemodynamics

Improvement in 11/20 patients

Greater reduction in NE, HVHF vs standard CVVH (68% vs 7%; p = 0.02)

Significant improvement (p < 0.05)

Significant improvement (p = 0.001)

Improvement in 11/20 patients

Significant improvement (p < 0.05)

Improvement in VP dose in the treatment group (p = 0.004)

No difference

Safety

–

No AE

–

–

–

–

No AE

Hypokalemia (30% in HVHF vs 20% in SVHF (p = 0.1)

Hypophosphatemia 88% in HVH vs 38 in SVHF (p = 0.01)

  1. HVHF high volume hemofiltration, LVHF low volume hemofiltration, SVHF standard volume hemofiltration, CVVH continuous veno-venous hemofiltration, UF ultrafiltrate, h hour, kg kilogram, NE norepinephrine, AE adverse events, VP vasopressor