Objective: To explore the efficacy of different doses of continuous renal replacement therapy (CRRT) in the treatment of severe pneumonia with acute kidney injury.
Methods: Twenty-eight patients with severe pneumonia and acute kidney injury were recruited from our hospital between February 2009 and March 2012. They divided into 3 groups: group A receiving a large dose of continuous veno-venous hemodiafiltration (CVVHDF) (70 ml×kg(-1)×h(-1), n = 9), group B a moderate dose of CVVHDF (45 ml×kg(-1)×h(-1), n = 8) and group C a low dose of CVVHDF (25 ml×kg(-1)×h(-1), n = 11). Before and after treatment, the changes of patient conditions, renal function and blood gas analysis were recorded. Such biomarkers as C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), interleukin-8 (IL-8), white blood cell (WBC) and neutrophil granulocyte (N) were determined.
Results: Compared with group C, the levels of leucocyte ((11.0 ± 3.2)×10(9)/L, (11.1 ± 5.3)×10(9)/L vs (8.5 ± 2.7)×10(9)/L), CRP ((89 ± 10), (90 ± 14) vs (107 ± 13) mg/L), TNF-α ((99 ± 39), (103 ± 28) vs (123 ± 35) pg/L), IL-6 ((54 ± 22), (69 ± 20) vs (81 ± 24) pg/L) and IL-8 ((104 ± 50), (138 ± 63) vs (167 ± 71) pg/L) decreased significantly in groups A and B after treatment (all P < 0.05). There were no differences in the levels of CRP, IL-6, IL-8 or TNF-α levels between groups B and C (all P > 0.05). The recovery of kidney function was much more rapid in group A than in groups B and C.
Conclusion: The large dose of CRRT may be more effective in the clearance of inflammatory mediators and improved survival of severe pneumonia with acute kidney injury than moderate and low doses.