High-volume versus standard-volume haemofiltration for septic shock patients with acute kidney injury (IVOIRE study): a multicentre randomized controlled trial
[en] PURPOSE : Septic shock is a leading cause of death among critically ill patients, in particular when complicated by acute kidney injury (AKI). Small experimental and human clinical studies have suggested that high-volume haemofiltration (HVHF) may improve haemodynamic profile and mortality. We sought to determine the impact of HVHF on 28-day mortality in critically ill patients with septic shock and AKI.
METHODS:
This was a prospective, randomized, open, multicentre clinical trial conducted at 18 intensive care units in France, Belgium and the Netherlands. A total of 140 critically ill patients with septic shock and AKI for less than 24 h were enrolled from October 2005 through March 2010. Patients were randomized to either HVHF at 70 mL/kg/h or standard-volume haemofiltration (SVHF) at 35 mL/kg/h, for a 96-h period.
RESULTS:
Primary endpoint was 28-day mortality. The trial was stopped prematurely after enrolment of 140 patients because of slow patient accrual and resources no longer being available. A total of 137 patients were analysed (two withdrew consent, one was excluded); 66 patients in the HVHF group and 71 in the SVHF group. Mortality at 28 days was lower than expected but not different between groups (HVHF 37.9 % vs. SVHF 40.8 %, log-rank test p = 0.94). There were no statistically significant differences in any of the secondary endpoints between treatment groups.
CONCLUSIONS:
In the IVOIRE trial, there was no evidence that HVHF at 70 mL/kg/h, when compared with contemporary SVHF at 35 mL/kg/h, leads to a reduction of 28-day mortality or contributes to early improvements in haemodynamic profile or organ function. HVHF, as applied in this trial, cannot be recommended for treatment of septic shock complicated by AKI.
Disciplines :
Anesthesia & intensive care
Author, co-author :
JOANNES-BOYAU, Olivier; CENTRE HOSPITALIER UNIVERSITAIRE de Bordeaux, France > Service d'Anesthésie-Réanimation 2
PEREZ, Paul; CHU BORDEAUX > Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique
BAGSHAW, Sean; UNIVERSITY OF ALBERTA - Edmonton (Canada) > Faculty of Medicine and Dentistery > Division of Critical Care Medicine
GRAND, Hubert; HOPITAL R. BOULIN - Libourne (France) > POLE EPURS > Réanimation Polyvalente
CANIVET, Jean-Luc ; Centre Hospitalier Universitaire de Liège - CHU > Soins Intensifs Généraux
DEWITTE, Antoine; CENTRE HOSPITALIER UNIVERSITAIRE de Bordeaux, France > Service d'Anesthésie-Réanimation 2
FLAMENS, Claire; HOPITAL CARDIOVASCULAIRE ET PNEUMOLOGIE LOUIS PRADEL de Lyon, France > Service d'Anesthésie-Réanimation
PUJOL, Wilfried; CLINIQUE BORDEAUX NORD AQUITAINE de Bordeaux, France > Service de Réanimation
GRANDOULIER, Anne-Sophie; CHU de Bordeaux, France > Pôle de Santé Publique et CIC-EC7 > Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (USMR)
FLEUREAU, Catherine; CENTRE HOSPITALIER de Bordeaux, France > Service d'Anesthésie-Réanimation 2
High-volume versus standard-volume haemofiltration for septic shock patients with acute kidney injury (IVOIRE study): a multicentre randomized controlled trial
Publication date :
September 2013
Journal title :
Intensive Care Medicine
ISSN :
0342-4642
eISSN :
1432-1238
Publisher :
Springer Verlag, New York, United States - New York
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