Hemofiltrate Reinfusion (HFR)-Supra during Sepsis-Associated (SA)-AKI Treats Inflammation and Improves Patient Outcomes

Background: Sepsis is life-threatening organ dysfunction caused by dysregulated response to an infection leading to systemic inflammation (SI). AKI is final common pathway of this immune dysregulation. KRT is often required in SA-AKI. HFR-Supra (HFR) trought is adsorbing resin cartridge that remove myoglobin, cytokines and pro-inflammatory mediators, have been used anecdotally. Aim of this study is to test HFR on outcome of SA-AKI in critically ill patients (pts). Methods: A retrospective observational study evaluated 16 SA-AKI pts. No ESKD pts in chronic dialysis. SA-AKI were treated with daily HFR-S. Given the laboratory operating standards they were assessed: urea, creatinine, C-reactive protein (CRP), procalcitonin (PCT), WBC, platelets (PLT), myoglobin, albumin, mean arterial pressure (MAP), need for vasopressor and outcome. The values have been reported as mean±SD or median and interquartile range. AKI was defined according to KDIGO. Statistical analyzes by Wilcoxon Test Results: Among 16 pts 10 had AKI III stage. Age was 73.1±11.1 y, 90% are hypertensive, some with heart disease, 60% with CKD, 60% obese or with diabetes. All received mechanical ventilation, 80% received amines. They underwent to 5.5±3.4 HFR treatments (range 2-13); Qb= 238±29.6 ml/m’, TT 233.2±45.8 m’. UF 477.9±185.5ml/h. HFR show significant abatement of CRP, PCT and myoglobin. Albumin remain stable. The effect on WBC and PLT reflect the trend of sepsis. Cardiovascular instability decreased allowing suspension of vasoactive amines given significant increase in MAP. (Tab. 1) 7 pts did not survive within follow four weeks, 5 pts had renal recovery, 2 pts had chronic dialysis. Conclusion: HFR represent a new strategy to decrease SI and support renal recovery in SA-AKI pts. The adsorbing resin is able to remove myoglobin, proinflammatory cytokines and many other mediators that improve MAP and reduce critical illness scores. HFR is safe and cheapest for SA-AKI in comparison to the CRRT, Cytosorb and others. Has excellent cost-effectiveness-sustainability ratio regarding treatment times and staff-sparing. Our evidence gradually help to build a new scientific evidence.