Intensive Care Medicine

, Volume 39, Issue 9, pp 1535–1546 | Cite as

High-volume versus standard-volume haemofiltration for septic shock patients with acute kidney injury (IVOIRE study): a multicentre randomized controlled trial

  • Olivier Joannes-Boyau
  • Patrick M. Honoré
  • Paul Perez
  • Sean M. Bagshaw
  • Hubert Grand
  • Jean-Luc Canivet
  • Antoine Dewitte
  • Claire Flamens
  • Wilfried Pujol
  • Anne-Sophie Grandoulier
  • Catherine Fleureau
  • Rita Jacobs
  • Christophe Broux
  • Hervé Floch
  • Olivier Branchard
  • Stephane Franck
  • Hadrien Rozé
  • Vincent Collin
  • Willem Boer
  • Joachim Calderon
  • Bernard Gauche
  • Herbert D. Spapen
  • Gérard Janvier
  • Alexandre Ouattara
Original

Abstract

Purpose

Septic shock is a leading cause of death among critically ill patients, in particular when complicated by acute kidney injury (AKI). Small experimental and human clinical studies have suggested that high-volume haemofiltration (HVHF) may improve haemodynamic profile and mortality. We sought to determine the impact of HVHF on 28-day mortality in critically ill patients with septic shock and AKI.

Methods

This was a prospective, randomized, open, multicentre clinical trial conducted at 18 intensive care units in France, Belgium and the Netherlands. A total of 140 critically ill patients with septic shock and AKI for less than 24 h were enrolled from October 2005 through March 2010. Patients were randomized to either HVHF at 70 mL/kg/h or standard-volume haemofiltration (SVHF) at 35 mL/kg/h, for a 96-h period.

Results

Primary endpoint was 28-day mortality. The trial was stopped prematurely after enrolment of 140 patients because of slow patient accrual and resources no longer being available. A total of 137 patients were analysed (two withdrew consent, one was excluded); 66 patients in the HVHF group and 71 in the SVHF group. Mortality at 28 days was lower than expected but not different between groups (HVHF 37.9 % vs. SVHF 40.8 %, log-rank test p = 0.94). There were no statistically significant differences in any of the secondary endpoints between treatment groups.

Conclusions

In the IVOIRE trial, there was no evidence that HVHF at 70 mL/kg/h, when compared with contemporary SVHF at 35 mL/kg/h, leads to a reduction of 28-day mortality or contributes to early improvements in haemodynamic profile or organ function. HVHF, as applied in this trial, cannot be recommended for treatment of septic shock complicated by AKI.

Keywords

Acute kidney injury Renal replacement therapy High volume hemofiltration Blood purification Septic shock 

Supplementary material

134_2013_2967_MOESM1_ESM.docx (55 kb)
Supplementary material 1 (DOCX 54 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2013

Authors and Affiliations

  • Olivier Joannes-Boyau
    • 1
    • 15
  • Patrick M. Honoré
    • 2
  • Paul Perez
    • 3
  • Sean M. Bagshaw
    • 4
  • Hubert Grand
    • 5
  • Jean-Luc Canivet
    • 6
  • Antoine Dewitte
    • 1
  • Claire Flamens
    • 7
  • Wilfried Pujol
    • 8
  • Anne-Sophie Grandoulier
    • 3
  • Catherine Fleureau
    • 1
  • Rita Jacobs
    • 2
  • Christophe Broux
    • 9
  • Hervé Floch
    • 10
  • Olivier Branchard
    • 1
  • Stephane Franck
    • 11
  • Hadrien Rozé
    • 1
  • Vincent Collin
    • 12
  • Willem Boer
    • 13
  • Joachim Calderon
    • 1
  • Bernard Gauche
    • 5
  • Herbert D. Spapen
    • 2
  • Gérard Janvier
    • 1
    • 14
  • Alexandre Ouattara
    • 1
    • 14
  1. 1.Service d’Anesthésie-Réanimation 2Centre Hospitalier Universitaire (CHU) de BordeauxBordeauxFrance
  2. 2.Universitair Ziekenhuis Brussel, Vrije Universitieit Brussel (VUB)BrusselsBelgium
  3. 3.Unité de Soutien Méthodologique à la Recherche Clinique et Épidémiologique (USMR), Pôle de Santé Publique et CIC-EC7Centre Hospitalier Universitaire (CHU) de BordeauxBordeauxFrance
  4. 4.Division of Critical Care Medicine, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
  5. 5.Réanimation PolyvalentePôle EPURS, Hopital R. BOULINLibourneFrance
  6. 6.Department of General Intensive CareUniversity Hospital of Liege, Domaine Universitaire de LiègeLiegeBelgium
  7. 7.Service d’Anesthésie et RéanimationHôpital Cardiovasculaire et Pneumologique Louis PradelLyonFrance
  8. 8.Service de RéanimationClinique Bordeaux Nord AquitaineBordeauxFrance
  9. 9.Department of Anesthesiology and Critical CareAlbert Michallon HospitalGrenobleFrance
  10. 10.Réanimation ChirurgicaleHôpital de Cavale Blanche, CHU de BrestBrestFrance
  11. 11.Department of Critical CareHôpital Tivoli, Université Libre de BruxellesLa LouvièreBelgium
  12. 12.Cliniques de l’Europe-Site St MichelBrusselsBelgium
  13. 13.Department of Anesthesiology and Critical Care MedicineZiekenhuis Oost-LimburgGenkBelgium
  14. 14.Univ. Bordeaux, Adaptation Cardiovasculaire à l’ischémiePessacFrance
  15. 15.Haut-Lévèque HospitalPessacFrance

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