OBJECTIVE. To evaluate the efficacy of continuous high-volume hemofiltration for the treatment of severe acute pancreatitis patients and the impact of acute physiology and chronic health evaluation (APACHE) II score on the efficacy of high-volume hemofiltration. MATERIAL AND METHODS. A total of 63 patients diagnosed with severe acute pancreatitis between January 2005 and July 2007 were retrospectively analyzed: 34 accepted adjunctive continuous high-volume hemofiltration (HVHF group); and 29 only accepted conventional recommended treatments (control group). RESULTS. There were no differences in physiological characteristics between the two groups when entering the intensive care unit. After treatment, the percentages of patients successfully weaned from mechanical ventilation (p = 0.004) and who experienced renal function recovery (p = 0.046) were significantly higher in the HVHF group than in the control group. The 28-day survival rate was 91.2% in the HVHF group, compared with 65.5% in the control group (p = 0.014). For patients with APACHE II scores > 15, survival was significant higher in the HVHF group than in the control group (87.5% vs 50%; p = 0.044). No difference in survival was found in patients with APACHE II scores < or = 15 between the two groups (94.4% vs 76.5%; p = 0.177). After HVHF therapy, APACHE II score, body temperature, urine volume and laboratory indices, including serum creatinine, base excess and blood calcium, were significantly improved. CONCLUSIONS. Adjunctive continuous HVHF was beneficial for the survival of severe acute pancreatitis patients. Survival improvement was significant in patients with APACHE II score > 15.