Prolonged intermittent high-volume hemofiltration as kidney replacement therapy in critically ill patients
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Date
2025
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Abstract
Background Prolonged and intermittent high-volume hemofltration (HVHF) can be performed in extremely critical patients for hemodynamic support. In addition, it can serve as a kidney replacement therapy, given its large ultrafltration volume. Our objective is to characterize the depuration properties of HVHF and hemodynamic tolerance. Methods This was a retrospective cohort study. All adult critical patients who received HVHF in a university hospital during 2021 were included. Demographic variables, past medical history, pre- and post-HVHF blood tests, and hemodynamic tolerance were evaluated. Results A total of 133 HVHF sessions were performed on 74 critical patients (age 61.1±14.8 years, 43.2% women, and sequential organ failure assessment (SOFA) score 15.5±3.8). All HVHF sessions were performed with preflter replacement fuid, and 83.5% without anticoagulation. Time (QT) was 337±86 min, with replacement fow rate (QR) at 81±21 mL/kg/h. Hypotension occurred in 19.6% of the procedures at connection and 6.8% during therapy with no precipitating factor. Norepinephrine dose decreased≥20% in 47.1% of the HVHF sessions. Single-pool urea Kt/V (spKt/V) was 0.52±0.17. In HVHF of QT 6–8 h, spKt/V was 0.58±0.17. Higher spKt/V was associated with higher QT and high QR. Post-HVHF sodium was signifcantly associated with sodium in the replacement fuid. Before HVHF, 18% had hyperkalemia (5.9±1.1 mEq/L). Post-therapy kalemia was 4.8±0.6 mEq/L. Post-HVHF potassium was associatedwith QR and ultrafltration. Conclusions Prolonged and intermittent HVHF could serve as an alternative kidney replacement therapy in critically ill patients because it provides adequate control of the internal environment, allows withdrawal anticoagulation, favors patient mobility for procedures and treatments, and provides hemodynamic support.
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Hemofltration, Hybrid renal replacement therapy, Critical illness, Acute kidney injury