THE ROLE OF HEMODIAFILTRATION IN PATIENTS WITH SEPSIS-ASSOCIATED ACUTE KIDNEY INJURY

Sepsis-associated acute kidney injury (S-AKI) is a critical complication occurring in 50% of patients with septic shock, with mortality rates ranging from 40% to 55%. Continuous veno-venous hemodiafiltration (CVVHDF) is a major continuous renal replacement therapy (CRRT) modality that combines diffusion and convection and may facilitate the removal of small solutes and selected inflammatory mediators. This narrative literature review aimed to synthesize the available evidence regarding the effects of CVVHDF on inflammatory mediator clearance, mortality, renal recovery, hemodynamic stability, treatment duration, and treatment-related complications in patients with S-AKI. This study employed a literature review approach using the keywords hemodiafiltration, CVVHDF, CRRT, S-AKI, sepsis, and AKI combined with Boolean operators. Literature searches were conducted in PubMed, Springer Nature, ScienceDirect, PLOS One, and Karger. The retrieved articles were systematically selected based on predefined inclusion and exclusion criteria. CVVHDF effectively reduced inflammatory mediators (IL-6, IL-8, and TNF-α) through combined diffusion and convection mechanisms. High-dose CVVHDF (80 mL/kg/hour) significantly reduced IL-6 (p = 0.03) and IL-8 (p = 0.01) levels within the first 24 hours. In addition, high cut-off (HCO) membranes achieved a significantly greater IL-6 reduction (79.21%) than standard high-flux membranes (p = 0.025). However, increasing dialysis dose intensity did not significantly improve 28-day survival (p = 0.9) or renal recovery. CVVHDF also demonstrated superior hemodynamic stability with a lower incidence of arrhythmias (p = 0.022) compared with conventional hemodialysis. Despite enhanced cytokine clearance, clinical outcomes were more strongly influenced by fluid management and timely therapy initiation than by increasing dialysis dose intensity. CVVHDF effectively modulates inflammatory responses and maintains hemodynamic stability in S-AKI. Clinical success depends more on appropriate volume management and timely initiation than on higher treatment intensity.