Paired randomization into four groups via central randomization center. Group 1: age 18-65 and <40%TBSA Group 2: age 18-65 and >40%TBSA Group 3: age >65 and <40%TBSA Group 4: age >65 and >40%TBSA

Contemporary care via consideration of the Burn-Specific Sepsis Bundle adapted form the most recent Surviving Sepsis campaign recommendations and specifically modified to our patient population.

70ml/kg/hr for treatment group for 48 hours with the following requirements:

• double lumen dialysis catheter should be placed in the internal jugular or femoral vein
• Anticoagulation will be determined by prescribing physician
• Use of 1.4 m2 or larger biocompatible synthetic hollow-fiber dialysis membrane that is changed every 24 hours
• Blood flow rate will be set to ensure a filtration fraction of no more than 25%
• Monitoring for electrolytes (specifically K+, Mg, Ca, and phos) during HVHF must be performed at least every 6 hours
• Replacement fluids will be bicarbonate-buffered with appropriate adjustments when citrate-anticoagulation is utilized
• All antibiotics will be dose adjusted for renal replacement therapy

Vasopressor dependency index = MAP/Inotropic score • This index will correct for the inter-center variability that exists with regards to the point (minimum MAP) at which vasopressors are initiated or weaned off. Thus, this eliminates the need to 'standardize' starting/stopping criteria of vasopressors.

Modified Inotropic index (30) = (dopamine dose X1)+(dobutamine dose X1)+(epi doseX100)+(norepi doseX100)+(phenylephrine doseX100)+(vasopressin doseX100)

• All units recorded at each time point in mcg/kg/min

Mean Arterial Pressure (mmHg)