title: Continuous Venovenous Hemofiltration (CVVH) Versus Conventional Treatment for Acute Severe Hypernatremia in Critically Ill Patients: A Retrospective Study.
abstract: Patients with severe hypernatremia who receive conventional treatment are often undertreated. Data on the management of acute hypernatremia using continuous venovenous hemofiltration (CVVH) are limited to anecdotes. This study aimed to evaluate the efficacy and safety of CVVH treatment for acute severe hypernatremia in critically ill patients in a retrospective cohort. A total of 95 patients who were admitted to our ICU between January 2009 and January 2014 were analyzed as the original cohort. These patients were divided into CVVH and conventional treatment groups. The patients in the conventional and CVVH groups were then matched by age, reason for ICU admission, vasopressor dependency, basic serum sodium concentration, and Glasgow scores. A Cox regression model was used to adjust the confounding variables. In the original cohort, the 28-day survival rates were 41.9% and 25.0% for the CVVH and conventional treatment groups, respectively. Conventional treatment (HR = 2.1, 95% CI 1.1-3.8, P = 0.019) was an independent predictor of patient mortality in the multivariate Cox regression model. In the matched cohort, the two groups were not significantly different in baseline characteristics. The CVVH group had a significantly greater reduction in the serum sodium concentration (0.78 [0.63-1.0] mmol/L/h versus 0.13 [0.009-0.33] mmol/L/h), P < 0.001) and an improved 28-day survival rate (34.8% vs. 8.7%, P = 0.002) compared with the conventional treatment group. The two groups did not differ significantly in treatment-related complications. CVVH treatment is possibly more effective than conventional treatment for the management of acute severe hypernatremia in critically ill patients.
authors.affiliation: Department of Nephrology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Ma
authors.forename: Ming
authors.initials: M
authors.lastname: Bai
authors.forename: Yangping
authors.initials: Y
authors.lastname: Li
authors.forename: Yan
authors.initials: Y
authors.lastname: Yu
authors.forename: Yirong
authors.initials: Y
authors.lastname: Liu
authors.forename: Meilan
authors.initials: M
authors.lastname: Zhou
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.forename: Rui
authors.initials: R
authors.lastname: Jing
authors.forename: Lijuan
authors.initials: L
authors.lastname: Zhao
authors.forename: Lijie
authors.initials: L
authors.lastname: He
authors.forename: Rong
authors.initials: R
authors.lastname: Li
authors.forename: Chen
authors.initials: C
authors.lastname: Huang
authors.forename: Hanmin
authors.initials: H
authors.lastname: Wang
authors.forename: Shiren
authors.initials: S
authors.lastname: Sun
mesh_terms: D000208:Acute Disease; D000328:Adult; D016638:Critical Illness / Q000628:therapy; D005260:Female; D006440:Hemofiltration / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D006955:Hypernatremia / Q000209:etiology / Q000628:therapy*; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome