To investigate patient's outcome using different hemofilter materials in those with sepsis associated acute renal failure

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Acute kidney injury (AKI) affects 5% to 7% of all hospitalized patients. Sepsis and septic shock remain the most important cause of AKI in critically ill patients and account for more than 50% of cases of AKI in the intensive care unit. The Acute Dialysis Quality Initiative has developed a consensus definition of AKI that uses the acronym RIFLE (Risk, Injury, Failure, Loss and End stage). Septic AKI is AKI occurring in the simultaneous presence of both the RIFLE criteria for AKI and the consensus criteria for sepsis, in the absence of other clear and established, non–sepsis-related (e.g., radiocontrast, other nephrotoxins) cause of AKI. It is widely accepted that cytokines play an important role in the pathogenesis of sepsis and septic shock. Cytokines removal by varies blood purification techniques like high volume hemofiltration and plasmaphresis may be useful in these situations. Polymethylmethacrylate (PMMA) membrane hemofilter remove cytokines from blood mainly by adsorption to membrane matrix of the hemofilter. This special membrane characteristic is absence in Polyacrylonitrate (PAN) or Polysulfone (PS) membrane hemofilter commonly used for continuous renal replacement therapy (CRRT). Studies showed that using PMMA based CRRT in patient with septic AKI may associate with early improvement of hemodynamics, oxygenation and improvement of urine output. When compared with PAN based CRRT, patients treated with PMMA based CRRT showed significant 28-days mortality benefit (61.5% vs. 15.4%). The aim of this study is to investigate whether citrate post-dilution continuous venovenous hemofiltration (CVVH) using PMMA based hemofilter (PMMA-CVVH) in the treatment of patient with septic AKI provide better clinical outcome compared with CVVH using polysulfone based hemofilter (PS-CVVH)

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