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In patients who do not achieve the target dose of RRT, despite optimization of the initial modality, a switch to another modality or the combination of different modalities should be considered.
Although there are insufficient data supporting a recommendation for elevated RRT doses in patients with AKI and septic shock, limited data suggest that a higher dose might be beneficial in some patients. A small singlecenter RCT was conducted in 20 patients with septic shock and AKI. Patients were randomized to either highvolume (effluent flow of 65 ml/kg/h) or low-volume CVVH (effluent flow of 35 ml/kg/h). The primary end-point was vasopressor dose required to maintain mean arterial pressure at 65mm Hg. Mean norepinephrine dose decreased more rapidly after 24 hours of high-volume as compared to low-volume CVVH treatment. Survival on day 28 was not affected.783
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