Early high‐dose continuous veno‐venous hemofiltration alleviates the alterations of CD4+ T lymphocyte subsets in septic patients combined with acute kidney injury

Background This study aims to determine whether early high‐dose continuous venous–venous hemofiltration (CVVH) alleviates the alterations in CD4+ T lymphocyte subsets in septic patients combined with acute kidney injury. Methods Enrolled septic patients combined with acute kidney injury were randomized into CVVH (n = 50) and conventional treatment (non‐CVVH, n = 53) groups. Healthy volunteers (n = 21) were enrolled. CVVH was initiated within 12 h of intensive care unit (ICU) admission with doses of 35~60 ml/kg/h and maintained for at least 72 h. Th1, Th2, Th17, and Treg were measured by flow cytometry on days 1, 3, and 7 of ICU admission. Sequential organ failure assessment (SOFA) scores were calculated. Results Th1 percentages and Th1/Th2 ratios were lower, and Th2, Th17, and Treg percentages and Th17/Treg ratios were higher in septic patients compared to healthy volunteers. CVVH significantly increased Th1 percentages and Th1/Th2 ratios, and significantly decreased Th2, Th17, and Treg percentages and Th17/Treg ratios compared to non‐CVVH. Th1 percentages and Th1/Th2 ratios were negatively correlated with SOFA scores, while Th2, Th17, and Treg percentages and Th17/Treg ratios were positively correlated with SOFA scores. Patients with CVVH had significantly lower SOFA scores on day 7 of ICU admission and a shorter ICU stay compared to those with non‐CVVH. Conclusions Septic patients combined with acute kidney injury exhibit different alterations of CD4+ T lymphocyte subsets. Early high‐dose CVVH alleviates the alterations, which may be one of the factors associated with improved sepsis severity. Septic patients combined with acute kidney injury exhibited decreased Th1 percentages and Th1/Th2 ratios, and increased Th2, Th17 and Treg percentages and Th17/Treg ratios; early high‐dose continuous venous‐venous hemofiltration (CVVH) alleviated these alterations. Th1 percentages and Th1/Th2 ratios were negatively correlated with sequential organ failure assessment (SOFA) scores, while Th2, Th17 and Treg percentages and Th17/Treg ratios were positively correlated with SOFA scores. Patients with CVVH had significantly lower SOFA scores and a shorter ICU stay.