Objective To evaluate the efficacy and mechanism of early repeated intermittent veno-venous hemofiltration (RIVVH) in treatment of severe acute pancreatitis (SAP). Methods Sixty-five patients were randomly divided into RIVVH group (35 cases) and control group (30 cases). Symptoms, physical signs, serum concentration of BUN, Cr, AST, ALT, AMS were observed and compared between two groups. The changes of C-reactive protein (CRP) and result of bacteria culture, APACHEⅡ grades and Balthazar CT grades, open-belly surgery rate, complications, mortality rate, average hospital stay and costs were compared between these two groups. Results Two patients died of multiple organ failure in the RIVVH group, with 5.7% mortality rate, which was significantly lower than that in the control group (26.7%, 8/30), P＜0.05. Twenty-four hours after treatment, symptoms and signs were alleviated more in RIVVH group; blood biochemical indicator, oxygenation index and CRP level improved significantly in RIVVH group compared with those in control group （P＜0.05，P＜0.01）. Balthazar CT grades and APACHEⅡ grades decreased significantly after treatment in patients of RIVVH group （P=0.002, P＜0.001）. The hospital stay, costs, open-belly surgery rate, complications rate and infection rate were also significantly lower in RIVVH group comparing with those in control group （P＜0.05, P＜0.001）. Conclusion RIVVH can decrease the mortality rate of SAP with high recovery rate, less cost and shorter hospital stay.