Cytokine-adsorbing hemofilter: old but new modality for septic acute kidney injury

Hattori, Noriyuki; Oda, Shigeto

doi:10.1186/s41100-016-0051-1

Cited by 41 publications

(57 citation statements)

References 50 publications

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“…These data confirm some experimental studies, in which oXiris filter improved the renal function and decreased the inflammatory response during sepsis and AKI [3]. This is not surprising, as the adsorbing membrane oXiris is a deriva- tive of AN69 surface treated hemofilter with a high adsorption capacity for cytokines and other mediators [8].…”

Section: Discussionsupporting

confidence: 76%

Continuous Renal Replacement Therapy with the Adsorbing Filter oXiris in Septic Patients: A Case Series

et al. 2019

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Background: Extracorporeal treatment may be useful during sepsis, but definitive recommendations are lacking. Aim of this study is to review retrospectively the medical records of septic patients submitted to continuous renal replacement therapy (CRRT) with the adsorbing membrane oXiris and evaluate (1) the safety of the device, (2) the cardiorenal response, and (3) the immunological response. Materials and Methods: The medical records of 60 septic patients submitted to CRRT with the membrane oXiris from April 2011 to December 2018 have been reviewed. The adsorbing membrane oXiris® (Baxter, IL, USA) was used through a Prisma plataform (Prismaflex – Baxter, IL, USA). At basal time (T0), at 24 h (T1), and at the end of the treatment (T2) were analyzed the clinical data, the cytokines, and the time course of endotoxin. Results: Sixty patients were included in the study. In total, 85% of patients had acute kidney injury (AKI). Every CRRT treatment was of 72 ± 13 h, with the consumption of 3.2 ± 1 filters. No AE events were reported. The main cardiorenal and respiratory parameters improved with a decrease of the noradrenaline dosage. Cytokines, procalcitonin, and endotoxin activity assay decreased too. SOFA total improved from 12.4 ± 2 to 9 ± 2. Conclusion: In sepsis/septic shock patients with AKI, CRRT with the adsorbing membrane oXiris may be safe and improves the cardiorenal – function and the clinical condition. The effect on cytokines and endotoxin may explain in part these results. A RCT is warranted to confirm these data.

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Section: Discussionsupporting

confidence: 76%

Continuous Renal Replacement Therapy with the Adsorbing Filter oXiris in Septic Patients: A Case Series

et al. 2019

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“…Although both of these therapies have demonstrated substantial cytokine removal [56,57], there were associated concerns about the exaggerated removal of beneficial molecules such as nutrients, proteins, and antimicrobial peptides [49]. Furthermore, trials using HVHF have also had mixed results in septic patients [53,58,59].…”

Section: History Of Cytokine Adsorption Therapymentioning

confidence: 99%

“…PMMA hemofiltration is currently indicated for the treatment of chronic kidney disease dependent on hemodialysis. However, the absorptive properties of the membrane make it an attractive adjunctive option in the treatment of sepsis-related organ dysfunction [49].…”

Section: History Of Cytokine Adsorption Therapymentioning

confidence: 99%

“…Historically, PMMA hemofilters were used as an adjunct to maintenance hemodialysis [49,74] and utilized PMMA molecules bound to a synthetic, polymeric membrane as a filter. The hydrophobic nature of the polymer permits ample diffusion of smalland medium-size solutes across the membrane while extracting cytokines and larger solutes such as proteins (e.g., albumin, uremic toxins, and immunoglobulin light chains) [7,49,75]. PMMA hemofiltration is currently indicated for the treatment of chronic kidney disease dependent on hemodialysis.…”

Section: History Of Cytokine Adsorption Therapymentioning

confidence: 99%

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Clinical Utility of Extracorporeal Cytokine Hemoadsorption Therapy: A Literature Review

et al. 2018

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Cytokines play a critical role in coordinating and amplifying a host immune response to infection. The normal pattern of localized and systemic release of proinflammatory and anti-inflammatory cytokines varies on the basis of the disease process. A dysregulated cytokine response can lead to a hyper-inflammatory condition called a cytokine storm. This is believed to contribute to the pathophysiology of sepsis and septic shock, a condition carrying high morbidity and mortality in critically ill patients. Extracorporeal cytokine hemoadsorption is an emerging technology utilized in the treatment of dysregulated inflammatory states such as sepsis, although there is a paucity of clinical evidence supporting its outcomes benefits. We assess the peer-reviewed literature relating to cytokine hemoadsorption in the context of sepsis and suggest areas of future research incorporating this novel technology.

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“…It consists of a proprietary 3 layer membrane structure. The base membrane is AN69, which is surface treated with polyethyleneimine and heparin is grafted to reduce membrane thrombogenicity [4]. When used clinically, oXiris-continuous veno-venous haemofiltration (CVVH) was shown to reduce SOFA score after 48 h compared to historical controls treated with polysulfone CVVH.…”

Section: Introductionmentioning

confidence: 99%

Augmented Adsorptive Blood Purification during Continuous Veno-Venous Haemodiafiltration in a Severe Septic, Acute Kidney Injury Patient: Use of oXiris®: A Single Centre Case Report

et al. 2019

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The use of the oXiris® haemofilter during continuous veno-venous haemodiafiltration (CVVHDF) for acute kidney injury (AKI) and severe sepsis is not completely understood. Although this filter has in vitro adsorptive properties for blood-borne cytokines and other humoural mediators of sepsis, its clinical usefulness is uncertain. Given its inherent adsorptive limitation for septic mediators, we developed a CVVHDF protocol in which the oXiris haemofilter was electively changed every 12 h even though there was no clotting or adverse circuit pressures. Augmented filter membrane adsorption was conducted for 3 consecutive days. We treated a critically ill patient with severe sepsis secondary to a gram-negative bacterial infection and sepsis-associated acute kidney injury (SA- AKI) in this way. The patient required high-dose vasopressor support, required mechanical ventilation, had received 12 h of CVVHDF with conventional M100 haemofilter, was on broad spectrum antibiotics and other conventional intensive care unit (ICU) care, prior to institution of the frequent oXiris haemofilter change protocol. Following the start of elective 12 hourly oXiris filter change, the patient showed reduction in the need for vasopressor and by Day 4 of this SA- AKI frequent filter change protocol, vasopressor requirement ceased, he was extubated. He survived ICU and but not hospital stay. To this end, more clinical studies are needed.

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Cytokine-adsorbing hemofilter: old but new modality for septic acute kidney injury

Cited by 41 publications

References 50 publications

Continuous Renal Replacement Therapy with the Adsorbing Filter oXiris in Septic Patients: A Case Series

Continuous Renal Replacement Therapy with the Adsorbing Filter oXiris in Septic Patients: A Case Series

Clinical Utility of Extracorporeal Cytokine Hemoadsorption Therapy: A Literature Review

Augmented Adsorptive Blood Purification during Continuous Veno-Venous Haemodiafiltration in a Severe Septic, Acute Kidney Injury Patient: Use of oXiris®: A Single Centre Case Report

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