Abstract: Objective To investigate the effect and mechanisms of high volume hemofiltration (HVHF) to septic shock induced acute kidney injury (AKI). Methods Eighteen pigs were randomly divided into control group, continuous renal replacement therapy (CRRT) group or HVHF group, and then intravenously infused with Escherichia coli lipopolysaccharide (LPS) to induce septic shock. Animals were given fluid resuscitation and vasoactive drugs to maintain tissue perfusion. After successful resuscitation, animals in the control group were managed without specific measures, and those in the other two groups were treated with continuous
venovenous hemofiltration (CVVH, ultrafiltration rate 25 ml/kg/h) or HVHF (ultrafiltration rate 85 ml/kg/ h). DATA about hemodynamic parameters, vasoactive drug dosage and therapeutic duration, plasma IL-6 and IL-10, NF-kB expression in kidney tissue, and kidney pathological changes were collected. Results Animal shock model was established after LPS administration for 40～60 min. Hemodynamic parameters were statistically different at 30 min, 40 min, 50 min and 60 min time points compared with the baseline status in each of the three groups (P＜0.05). The dPmax at T4, T5 and T6 time points were significantly higher in HVHF group than in the other two groups (P＜0.05). Fluid resuscitation volume was significantly lower in HVHF group than in the other two groups (P＜0.01), and was significantly lower in CRRT group than in control group (P＜0.05). Norepinephrine dosage decreased more at T4, T5, T6 time points than at baseline (P＞0.05) in HVHF group, and the difference was statistically significant as compared with that in the other two groups (P＜0.01). Plasma IL-6 decreased more at T3-T6 time points and plasma IL-10 decreased more at T2-T6 time points in HVHF group than in CRRT group (P＜0.05). NF-kB mRNA in kidney was lower in HVHF group than in the other two groups (P＜0.01), and was lower in CRRT group than in the control group (P＜0.05). Kidney pathology
score was lower in HVHF than in the other two groups (P＜0.01). Conclusion HVHF led to the decreases of vasoactive drug dosage, fluid volume for resuscitation, NF-kB expression in kidney, inflammatory cytokine expression, and kidney pathological changes, thus protected the kidney from AKI during septic
shock.

Key words: High volume Hemofiltration, septic shock, Inflammatory medium, AKI, NF-kB