title: Extended daily on-line high-volume haemodiafiltration in septic multiple organ failure: a well-tolerated and feasible procedure.
abstract: BACKGROUND
  The outcome of patients with septic multiple organ failure (MOF) remains poor. There are experimental and clinical data indicating a beneficial effect of high-volume haemofiltration. Delivering high-volume therapy is only cost effective using on-line devices because of high costs for additional solution bags in conventional continuous renal replacement therapy (CRRT). We investigated feasibility and effectiveness of extended daily on-line high-volume haemodiafiltration (HDF) with technically maximum convective volume in patients with septic MOF in a pilot study.
  
  
  METHODS
  We included 21 consecutive critically ill patients with septic MOF having a mortality risk >50% (SAPS II >50, APACHE II >25). Renal replacement therapy (RRT) was applied with extended daily HDF for 6-23 h using the AK 200 Ultra S dialysis machine in the ultracontrol pre-dilution mode. Dialysate and substitution fluid were prepared on-line. Patients underwent 289 treatments.
  
  
  RESULTS
  The mean convective volume was 17.8 ± 3.7 L/h and 208 ± 66 mL/kg/h, respectively, median treatment time was 10:15 h/day. Seventeen of 21 patients survived 28 days (81%). The 90-day survival rate was 52% (11/21) versus 19% compared to the survival rate predicted by APACHE II (33.6 mean) and SAPS II (68.6 mean) scores. Haemodynamics improved significantly during the treatment procedures. Material costs per treatment amounted to 35 €.
  
  
  CONCLUSIONS
  Extended daily on-line HDF using maximum convective volume seems to improve the outcome of septic MOF, especially in the early phase. The investigated mode of treatment proved to be feasible, well tolerated and highly cost effective compared to conventional CRRT. At present, this procedure would be applicable at every ICU facility with nephrological support.
authors.affiliation: KfH Kidney Centre, Berlin-Köpenick, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Kron
authors.forename: Susanne
authors.initials: S
authors.lastname: Kron
authors.forename: Reinhard
authors.initials: R
authors.lastname: Wenkel
authors.forename: Hans-Uwe
authors.initials: HU
authors.lastname: Schuhmacher
authors.forename: Ulrike
authors.initials: U
authors.lastname: Thieme
authors.forename: Til
authors.initials: T
authors.lastname: Leimbach
authors.forename: Hartmut
authors.initials: H
authors.lastname: Kern
authors.forename: Hans-H
authors.initials: HH
authors.lastname: Neumayer
authors.forename: Torsten
authors.initials: T
authors.lastname: Slowinski
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness / Q000401:mortality*; D005240:Feasibility Studies; D005260:Female; D017583:Hemodiafiltration / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000191:economics / Q000209:etiology / Q000628:therapy*; D009862:Online Systems / Q000706:statistics & numerical data*; D010865:Pilot Projects; D011446:Prospective Studies; D006435:Renal Dialysis; D017582:Renal Replacement Therapy; D018805:Sepsis / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome