The Efficacy and Safety of Continuous Veno‐Venous Hemodiafiltration With High Cutoff Membrane Versus High Flux Membrane in Septic Acute Kidney Injury: A Randomized Controlled Study

ABSTRACT Background The application of high cutoff (HCO) membranes for continuous renal replacement therapy remains unclear in septic acute kidney injury (S‐AKI) patients. Methods S‐AKI patients who received continuous veno‐venous hemodiafiltration (CVVHDF) were randomly assigned to the experimental group (HCO membrane) and the control group (high flux membrane, HF membrane). Interleukin‐6 (IL‐6) and tumor necrosis factor‐α (TNF‐α) in serum and waste fluid were measured at 0, 2, 12, and 24 h after CVVHDF initiation and the 28‐day mortality. Results Eleven patients were randomized to the HCO group, and 9 patients in the HF group, with a mean age of 54.9 ± 3.2 years and 6 patients (30%) being female. After 24 h of treatment with CVVHDF, there were significant reductions in serum IL‐6 and TNF‐α concentrations in the HCO group ( p = 0.001, 0.015) and HF group ( p = 0.004, 0.031). The serum IL‐6 reduction rate of the HCO group was significantly higher than that of the HF group (79.21% vs. 42.69%, p = 0.025), while serum TNF‐α reduction rates were comparable between the 2 groups. There were no significant changes in serum albumin after 24 h using either HCO membrane (28.7 ± 1.7 g/L vs. 32.7 ± 1.6 g/L, p = 0.138) or HF membrane (29.6 ± 1.1 g/L vs. 32.6 ± 1.3 g/L, p = 0.055). The two groups had similar 24‐h filter clotting rates and 28‐day mortality. Conclusion While CVVHDF with the HCO membrane and HF membrane both achieved significant reductions in serum cytokine levels, the HCO membrane was associated with a greater reduction rate in IL‐6 but not in TNF‐α. No difference was observed in serum albumin, mortality, or filter clotting. Trial Registration Registry number: ChiCTR2000039725