***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Objective To evaluate the effects of short-term , high-volume hemofiltration ( STHVH ) on hemodynamic and metabolic status and 28-day survival in patients with refractory septic shock . Design Prospect i ve , interventional . Setting Intensive care unit ( ICU ) , tertiary institution . Patients Twenty patients with intractable cardiocirculatory failure complicating septic shock , who had failed to respond to conventional therapy . Interventions STHVH , followed by conventional continuous venovenous hemofiltration . STHVH consisted of a 4-hr period during which 35 L of ultrafiltrate is removed and neutral fluid balance is maintained . Subsequent conventional continuous venovenous hemofiltration continued for at least 4 days . Measurements and Main Results Cardiac index , systemic vascular resistance , pulmonary vascular resistance , oxygen delivery , mixed venous oxygen saturation , arterial pH , and lactate were measured serially . Fluid and inotropic support were managed by protocol . Therapeutic endpoints were as follows during STHVH : a ) by 2 hrs , a ≥50 % increase in cardiac index ; b ) by 2 hrs , a ≥25 % increase in mixed venous saturation ; c ) by 4 hrs , an increase in arterial pH to > 7.3 ; d ) by 4 hrs , a ≥50 % reduction in epinephrine dose . Patients who attained all four goals ( 11 of 20 ) were considered hemodynamic “ responders ” ; patients who did not ( 9 of 20 ) were considered hemodynamic “ nonresponders . ” There were no differences in baseline hemodynamic , metabolic , and Acute Physiology and Chronic Health Evaluation and Simplified Acute Physiology Scores between responders and nonresponders . Survival to 28 days was better among responders ( 9 of 11 patients ) than among nonresponders ( 0 of 9 ) . Factors associated with survival were hemodynamic-metabolic response status , time interval from ICU admission to initiation of STHVH , and body weight . Conclusions These data suggest that STHVH may be of major therapeutic value in the treatment of intractable cardiocirculatory failure complicating septic shock . Early initiation of therapy and adequate dose may improve hemodynamic and metabolic responses and 28-day survival BACKGROUND There is uncertainty on the effect of different dialysis modalities for the treatment of patients with acute kidney injury ( AKI ) , admitted to the intensive care unit ( ICU ) . This controlled clinical trial performed in the framework of the multicentre SHARF 4 study ( Stuivenberg Hospital Acute Renal Failure ) aim ed to investigate the outcome in patients with AKI , stratified according to severity of disease and r and omized to different treatment options . METHODS This was a multicentre prospect i ve r and omized controlled trial with stratification according to severity of disease expressed by the SHARF score . ICU patients were eligible for inclusion when serum creatinine was > 2 mg/dL , and RRT was initiated . The selected patients were r and omized to intermittent ( IRRT ) or continuous renal replacement therapy ( CRRT ) . RESULTS A total of 316 AKI patients were r and omly assigned to IRRT ( n = 144 ) or CRRT ( n = 172 ) . The mean age was 66 ( range 18 - 96 ) ; 59 % were male . Intention-to-treat analysis revealed a mortality of 62.5 % in IRRT compared to 58.1 % in CRRT ( P = 0.430 ) . No difference between IRRT and CRRT could be observed in the duration of ICU stay or hospital stay . In survivors , renal recovery at hospital discharge was comparable between both groups . Multivariate analysis , including the SHARF score , APACHE II and SOFA scores for correction of disease severity , showed no difference in mortality between both treatment modalities . This result was confirmed in pre-specified subgroup analysis ( elderly , patients with sepsis , heart failure , ventilation ) and after exclusion of possible confounders ( early mortality , delayed ICU admission ) . CONCLUSIONS Modality of RRT , either CRRT or IRRT , had no impact on the outcome in ICU patients with AKI . Both modalities need to be considered as complementary in the treatment of AKI ( Clinical Trial : SHARF 4 , NCT00322933 , http:// Clinical Trials.gov ) BACKGROUND Continuous veno-venous haemofiltration is increasingly used to treat acute renal failure in critically ill patients , but a clear definition of an adequate treatment dose has not been established . We undertook a prospect i ve r and omised study of the impact different ultrafiltration doses in continuous renal replacement therapy on survival . METHODS We enrolled 425 patients , with a mean age of 61 years , in intensive care who had acute renal failure . Patients were r and omly assigned ultrafiltration at 20 mL h(-1 ) kg(-1 ) ( group 1 , n=146 ) , 35 mL h(-1 ) kg(-1 ) ( group 2 , n=139 ) , or 45 mL h(-1 ) kg(-1 ) ( group 3 , n=140 ) . The primary endpoint was survival at 15 days after stopping haemofiltration . We also assessed recovery of renal function and frequency of complications during treatment . Analysis was by intention to treat . RESULTS Survival in group 1 was significantly lower than in groups 2 ( p=0.0007 ) and 3 ( p=0.0013 ) . Survival in groups 2 and 3 did not differ significantly ( p=0.87 ) . Adjustment for possible confounding factors did not change the pattern of differences among the groups . Survivors in all groups had lower concentrations of blood urea nitrogen before continuous haemofiltration was started than non-survivors . 95 % , 92 % , and 90 % of survivors in groups 1 , 2 , and 3 , respectively , had full recovery of renal function . The frequency of complications was similarly low in all groups . INTERPRETATION Mortality among these critically ill patients was high , but increase in the rate of ultrafiltration improved survival significantly . We recommend that ultrafiltration should be prescribed according to patient 's bodyweight and should reach at least 35 mL h(-1 ) kg(-1 ) BACKGROUND Despite the widespread use of continuous renal replacement therapy in critically ill patients with acute renal failure ( ARF ) , there are few data supporting its benefits over conventional intermittent hemodialysis ( IHD ) . We sought to analyze differences in survival between modalities in a study that compared continuous venovenous hemodialysis ( CVVHD ) with IHD . METHODS Eighty critically ill patients with ARF requiring dialysis were r and omized after stratification by severity of illness to treatment with CVVHD or IHD .  RESULTS There were no differences in survival or renal recovery between groups . In patients who died , mean survival time was 10.7 + /- 11.2 days for the IHD group versus 14.3 + /- 16.1 days for the CVVHD group ( P = not significant ) . There was greater net volume removal in the CVVHD group during 72 hours . Declines in urine output during 72 hours were similar between groups . Mean arterial pressure off and on dialysis therapy was analyzed retrospectively . There was a significant decrease in mean arterial pressure for patients on IHD therapy not seen in those on CVVHD therapy , but this did not lead to a survival advantage . CONCLUSION Despite greater volume control , CVVHD did not lead to an improvement in survival , preservation of urine output , or renal recovery compared with IHD in patients with ARF Introduction We conducted a study to evaluate the incidence , risk factors and outcomes associated with early acute kidney injury ( AKI ) in sepsis . Methods The study was a retrospective interrogation of prospect ively collected data from the Australian New Zeal and Intensive Care Society Adult Patient Data base . Data were collected from 57 intensive care units ( ICUs ) across Australia . In total , 120,123 patients admitted to ICU for more than 24 hours from 1 January 2000 to 31 December 2005 were included in the analysis . The main outcome measures were clinical and laboratory data and outcomes . Results Of 120,123 patients admitted , 33,375 had a sepsis-related diagnosis ( 27.8 % ) . Among septic patients , 14,039 ( 42.1 % ) had concomitant AKI ( septic AKI ) . Sepsis accounted for 32.4 % of all patients with AKI . For septic AKI stratified by RIFLE ( risk of renal failure , injury to the kidney , failure of kidney function , loss of kidney function and end-stage kidney disease ) category , 38.5 % of patients belonged to the risk category , 38.8 % to the injury category and 22.7 % to the failure category . Septic AKI patients had greater acuity of illness ( P < 0.0001 ) , lower blood pressure ( P < 0.0001 ) , higher heart rates ( P < 0.0001 ) , worse pulmonary function measures by arterial oxygen tension/fraction of inspired oxygen ratio ( P < 0.0001 ) , greater acidaemia ( P < 0.0001 ) and higher white cell counts ( P < 0.0001 ) compared with patients with nonseptic AKI . Septic AKI was also associated with greater severity of AKI ( RIFLE category injury or failure ) compared with nonseptic AKI . Septic AKI was associated with a significantly higher crude and co-variate adjusted mortality in the ICU ( 19.8 % versus 13.4 % ; odds ratio 1.60 , 95 % confidence interval 1.5 to 1.7 ; P < 0.001 ) and in hospital ( 29.7 % versus 21.6 % ; odds ratio 1.53 , 95 % confidence interval 1.46 to 1.60 ; P < 0.001 ) compared with nonseptic AKI . Septic AKI was associated with higher ICU and hospital mortality across all strata of RIFLE categories . Septic AKI patients had longer duration s of stay in both ICU and hospital across all strata of RIFLE categories . ConclusionS eptic AKI is common during the first 24 hours after ICU admission . Patients with septic AKI are generally sicker , with a higher burden of illness , and have greater abnormalities in acute physiology compared with patients with nonseptic AKI . Moreover , septic AKI is independently associated with higher odds of death and longer duration of hospitalization BACKGROUND Increasing the dose of renal replacement therapy has been shown to improve survival in critically ill patients with acute kidney injury ( AKI ) in several smaller European trials . However , a very recent large multicentre trial in the USA could not detect an effect of dose of renal replacement therapy on mortality . Based on those studies , it is not known whether a further increase in dialysis dose above and beyond the currently employed doses would improve survival in patients with AKI . We therefore aim ed to assess mortality and renal recovery of patients with AKI receiving either st and ard ( SED ) or intensified extended dialysis ( IED ) therapy in the intensive care unit . METHODS A prospect i ve r and omized parallel group study was conducted in seven intensive care units of a tertiary university hospital . Pre-existing chronic kidney disease was an exclusion criterion . A total of 156 patients ( 570 screened ) with AKI requiring renal replacement therapy were r and omly assigned to receive st and ard dialysis [ dosed to maintain plasma urea levels between 120 and 150 mg/dL ( 20 - 25 mmol/L ) ] or intensified dialysis [ dosed to maintain plasma urea levels < 90 mg/dL ( < 15 mmol/L ) ] . Outcome measures were survival at Day 14 ( primary ) and survival and renal recovery at Day 28 ( secondary ) after initiation of renal replacement therapy . RESULTS Treatment intensity differed significantly ( P < 0.01 for plasma urea and administered dose ) . No differences between intensified and st and ard treatment were seen for survival by Day 14 ( 70.4 % versus 70.7 % ) or Day 28 ( 55.6 % versus 61.3 % ) , or for renal recovery amongst the survivors by Day 28 ( 60.0 % versus 63.0 % ) . CONCLUSIONS Although this study can not deliver a definitive answer , it suggests that increasing the dose of extended dialysis above the currently recommended dose might neither reduce mortality nor improve renal recovery in critically ill patients , mainly septic patients , with AKI Objective To study the effect of early and continuous venovenous hemofiltration ( CVVH ) on the plasma concentrations of several humoral mediators of inflammation and subsequent organ dysfunction in septic patients . Design R and omized , controlled trial . Setting Intensive care unit of a tertiary hospital . Patients Twenty-four patients with early septic shock or septic organ dysfunction . Interventions R and om allocation to receive 48 hrs of isovolemic CVVH at 2 L/hr of fluid exchange or no hemofiltration . Measurements and Main Results We measured the plasma concentrations of complement fractions C3a and C5a , interleukins 6 , 8 , and 10 , and tumor necrosis factor & agr ; at baseline and 2 , 24 , 26 , 48 , and 72 hrs . A multiple 
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The effect on mortality was not modified ( interaction P values non significant ) by the dose of continuous renal replacement therapies , the severity of illness or the risk of bias .
The available evidence suggests that these therapies in patients with severe sepsis or septic shock are not associated with an improvement in other outcomes such as haemodynamics , pulmonary gas exchange , multiple organ dysfunction syndrome or length of stay .
The best available evidence does not support the routine use of continuous renal replacement therapies ( at traditional or high doses ) in patients with severe sepsis or septic shock