Continuous Hemodiafiltration with a Cytokine-Adsorbing Hemofilter for Sepsis

Abstract

Since the introduction of the new pathophysiological concept of pathogen-associated molecular patterns (PAMPS) and alarmins, endotoxin has been recognized as only one of the PAMPS. It is widely accepted that hypercytokinemia plays a pivotal role in the pathophysiology of sepsis. Many kinds of blood purification modalities have been proposed as a therapeutic tool against sepsis, including high-volume continuous hemofiltration whose efficacy has recently been questioned. We report that continuous hemodiafiltration (CHDF) with a cytokine-adsorbing hemofilter (CAH), such as polymethyl methacrylate hemofilter and AN69ST hemofilter (CAH-CHDF), can remove many kinds of cytokines and has been very effective in the treatment of severe sepsis and septic shock. Based on the understanding of the recent pathophysiology, we suggest that CAH-CHDF is an alternate therapy to direct hemoperfusion with endotoxin-adsorbing column in the treatment of sepsis.

Effect of continuous hemodiafiltration using an AN69ST membrane in patients with sepsis

“…Our study is distinctive in that we focused on patients with sepsis. Some previous studies have reported that CHDF using an AN69ST membrane showed significantly better survival than expected in patients with sepsis [14,15]. The present report showed nearly equal survival between AN69ST and PMMA membranes, indicating the effectiveness of AN69ST.…”

Associations of Polyethylenimine-Coated AN69ST Membrane in Continuous Renal Replacement Therapy with the Intensive Care Outcomes: Observations from a Claims Database from Japan

“…Hypercytokinemia is observed in a variety of serious conditions in ICU patients, including sepsis, trauma, pancreatitis, and burns, and plays a key role in the inflammation cascade [41]. In particular, plasma cytokine levels such as IL-6 and high-mobility group protein B1 are increased with impaired kidney function [42,43,44,45].…”

Continuous Hemodiafiltration with a Cytokine-Adsorbing Hemofilter in Patients with Septic Shock: A Preliminary Report

“…Since it is now evident that high-volume hemofiltration, which according to recent consensus guidelines is not to be used for sepsis patients without renal failure [25], and since a latest study indicates lack of its efficacy in septic shock complicated by acute kidney injury [26], CAH-CHDF is a potentially effective blood purification modality for removing cytokines from the blood [27]. As AN69ST membrane is a cytokine-adsorbing membrane, the high capacity of cytokine removal with AN69ST-CHDF is thought to be principally ascribable to adsorption of cytokines to the hemofilter membrane rather than convection and diffusion [11]. Therefore, we think, there is little relationship between the amount of dialysis dose and the cytokine removal rate.…”

“…Moreover, our group indicates that blood IL-6 level is correlated with severity of hyperglycemia and difficulties in glucose control [29]. CAH-CHDF, a countermeasure against hypercytokinemia, should become a mainstay of the therapeutic approach to septic shock along with the effective control of infection [11]. …”

“…The survival rates of septic shock patients who were treated in accordance with the SSCG in recently reported studies were used as an external control. The ratio of observed survival to predicted survival according to the patients' APACHE II scores (O/P survival ratio) [11] was compared between the present study and previous studies.…”