Abstract: Objective To assess the therapeutic effect of daytime high-volume hemofiltration (HVHF) on septic shock patients combined with acute kidney injury (AKI). Methods A total of 50 septic shock cases complicated with AKI and treated in the ICU during the period from Oct. 2013 to Jun. 2015 were enrolled in this study. They were randomly divided into treatment group (treated with daytime HVHF, n=25) or control group (treated with CVVH, n=25). Serum tumor necrosis factor alpha (TNFα), interleukin-10 (IL-10), lactic acid (Lac), BUN and creatinine were measured. Central venous pressure (CVP) was monitored. The norepinephrine dose needed to maintain average arterial pressure at 65-70 mmHg and the normal oxygenation indices were recorded. APACHE II score, mechanical ventilation duration, days in ICU, hospitalization days, and mortality in hospital were also collected. Results After the treatment, serum TNF-α and IL-10 levels decreased in both groups. The decrease of TNF-α and IL-10 levels was more in treatment group than in control group. Serum IL-10 levels were 62.32±11.39 μg/l and 70.82 ± 13.31 μg/l (t=2.425, P=0.019) in treatment group and control group respectively at the 48th hour after the treatment, and were 57.36±13.83 μg/l and 68.23 ±12.73 μg/l (t=2.893; P=0.006) in treatment group and control group respectively at the 72nd hour after the treatment. Serum TNF-α levels were 94.16±15.11 μg/l and 104.81±13.30 μg/l (t=2.646, P=0.011) in treatment group and control group respectively at the 72nd hour after the treatment. Hemodynamics, respiration, renal function and APACHE II score improved after the treatment in both groups, and improved more in treatment group than in control group. Norepinephrine doses used were 0.67±0.14 μg/kg/min and 0.75±0.10 μg/kg/min (t=2.228, P=0.031) in treatment group and control group respectively at the 24th hour after the treatment, and APACHE II scores were 24.20±2.83 and 27.44±3.30 (t= 3.732, P=0.001) in treatment group and control group respectively at the 24th hour after the treatment. The oxygenation indices were 270.40 ± 37.72 mmHg and 244.76±39.66 mmHg (t=-2.343; P=0.023) in treatment group and control group respectively at the 48th hour after the treatment. Mechanical ventilation duration, days in ICU, and hospitalization days were 63.2±12.8 hours, 81.8±7.2 hours, and 6.3±2.1 days respectively in treatment group, and were 7.8±2.3 days, 12.8±4.1 days, and 15.6±3.9 days respectively in control group (t=6.363, P＜0.001 for mechanical ventilation duration; t=2.409, P=0.020 for days in ICU; t=2.527, P=0.015 for hospitalization days). Conclusion Daytime HVHF can significantly improve the prognosis of severe septic shock patients, clinically showing recovery of respiration/ circulation failure, alleviation of systemic inflammation, and decrease of APACHEII score.

Key words: acute kidney injure, daytime high-volume hemofiltration(HVHF), inflammatory factor