Effect of hemofiltration on hemodynamics and systemic concentrations of anaphylatoxins and cytokines in human sepsis

Hoffmann, J. N.; Hartl, Wolfgang H.; Deppisch, Reinhold; Faist, Eugen; Jochum, Marianne; Inthorn, D.

doi:10.1007/bf01709552

Cited by 95 publications

(36 citation statements)

References 43 publications

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“…A few papers reported on hybrid therapies such as combined plasma filtration adsorption, 32 adsorption combined with standard hemodiafiltration 14 and plasma filtration combined with standard hemodiafiltration. 47 Standard techniques include both hemofiltration using standard filters at standard doses 13,17,18,20,22,23,35,[39][40][41]43,49,51 as well as hemofiltration at high volume doses 19,49 according to current definitions; with the latter labeled as HVHF. Standard or high cut-off techniques included continuous hemofiltration, 13,[15][16][17][18]20,22,23,35,[39][40][41]43,49,51 continuous hemodialysis 15,18,27,45 and continuous hemodiafiltration.…”

Section: Resultsmentioning

confidence: 99%

“…47 Standard techniques include both hemofiltration using standard filters at standard doses 13,17,18,20,22,23,35,[39][40][41]43,49,51 as well as hemofiltration at high volume doses 19,49 according to current definitions; with the latter labeled as HVHF. Standard or high cut-off techniques included continuous hemofiltration, 13,[15][16][17][18]20,22,23,35,[39][40][41]43,49,51 continuous hemodialysis 15,18,27,45 and continuous hemodiafiltration. 21,[24][25][26]36 The main cytokines measured in the clinical studies were interleukin-1b (IL-1b), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-alpha) and interleukin-1 receptor antagonist (IL-1Ra) Other cytokines measured were interleukin-2 (IL-2), interleukin-2 receptor (IL-2R), interleukin-6 receptor (IL-6R) and soluble TNF-alpha receptors I and II (sTNFaRI and sTNFaRII).…”

Section: Resultsmentioning

confidence: 99%

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Techniques of extracorporeal cytokine removal: a systematic review of human studies

2013

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Background and aims: Hypercytokinemia is believed to be harmful and reducing cytokine levels is considered beneficial. Extracorporeal blood purification (EBP) techniques have been studied for the purpose of cytokine reduction. We aimed to study the efficacy of various EBP techniques for cytokine removal as defined by technical measures. Method: We conducted a systematic search for human clinical trials which focused on technical measures of cytokine removal by EBP techniques. We identified 41 articles and analyzed cytokine removal according to clearance (CL), sieving coefficient (SC), ultrafiltrate (UF) concentration and percentage removed. Results: We identified the following techniques for cytokine removal: standard hemofiltration, high volume hemofiltration (HVHF), high cut-off (HCO) hemofiltration, plasma filtration techniques, and adsorption techniques, ultrafiltration (UF) techniques relating to cardiopulmonary bypass (CPB), extracorporeal liver support systems and hybrid techniques including combined plasma filtration adsorption. Standard filtration techniques and UF techniques during CPB were generally poor at removing cytokines (median CL for interleukin 6 [IL-6]: 1.09 mL/min, TNF-alpha 0.74 mL/min). High cut-off techniques consistently offered moderate cytokine removal (median CL for IL-6: 26.5 mL/min, interleukin 1 receptor antagonist [IL-1RA]: 40.2 mL/ min). Plasma filtration and extracorporeal liver support appear promising but data are few. Only one paper studied combined plasma filtration and adsorption and found low rates of removal. The clinical significance of the cytokine removal achieved with more efficacious techniques is unknown. Conclusion: Human clinical trials indicate that high cut-off hemofiltration techniques, and perhaps plasma filtration and extracorporeal liver support techniques are likely more efficient in removing cytokines than standard techniques.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Techniques of extracorporeal cytokine removal: a systematic review of human studies

2013

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“…It should be noted, however, that in the Rogiers study the body temperature fell below baseline with the lowest value of 36.1°C, which is in marked contrast to our results. Alternatively, cutting the plasma peak concentrations of cytokines [37] without a measurable effect on plasma cytokines levels or elimination of other unmeasured vasodilatory or inflammatory mediators [9,[38][39][40] could have explained the observed systemic hemodynamic effects of haemofiltration. Finally, removal of sedative drugs leading to an increased sympathetic drive of animals cannot be completely excluded.…”

Section: Discussionmentioning

confidence: 99%

High versus standard-volume haemofiltration in hyperdynamic porcine peritonitis: effects beyond haemodynamics?

et al. 2008

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Objective: The role of haemofiltration as an adjunctive treatment of sepsis remains a contentious issue. To address the role of dose and to explore the biological effects of haemofiltration we compared the effects of standard and high-volume haemofiltration (HVHF) in a peritonitis-induced model of porcine septic shock. Design and setting: Randomized, controlled experimental study. Subjects: Twenty-one anesthetized and mechanically ventilated pigs. Interventions: After 12 h of hyperdynamic peritonitis, animals were randomized to receive either supportive treatment (Control, n = 7) or standard haemofiltration (HF 35 ml/ kg per h, n = 7) or HVHF (100 ml/kg per hour, n = 7). Measurements and results: Systemic and hepatosplanchnic haemodynamics, oxygen exchange, energy metabolism (lactate/pyruvate, ketone body ratios), ileal and renal cortex microcirculation and systemic inflammation (TNF-a, IL-6), nitrosative/oxidative stress (TBARS, nitrates, GSH/GSSG) and endothelial/coagulation dysfunction (von Willebrand factor, asymmetric dimethylarginine, platelet count) were assessed before, 12, 18, and 22 h of peritonitis. Although fewer haemofiltration-treated animals required noradrenaline support (86, 43 and 29% animals in the control, HF and HVHF groups, respectively), neither of haemofiltration doses reversed hyperdynamic circulation, lung dysfunction and ameliorated alterations in gut and kidney microvascular perfusion. Both HF and HVHF failed to attenuate sepsisinduced alterations in surrogate markers of cellular energetics, nitrosative/oxidative stress, endothelial injury or systemic inflammation. Conclusions: In this porcine model of septic shock early HVHF proved superior in preventing the development of septic hypotension. However, neither of haemofiltration doses was capable of reversing the progressive disturbances in microvascular, metabolic, endothelial and lung function, at least within the timeframe of the study and severity of the model.

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“…CVVH is used with the conviction that convective therapy removes cytokines and reduces the effects of the systemic inflammatory response syndrome. However, controlled studies have failed to show a significant or sustained reduction in cytokine plasma concentrations with CVVH or an improvement in outcome (76)(77)(78)(79)(80)(81). A recent meta-analysis comparing the outcomes of hemofiltration with hemodialysis for the treatment of AKI found no benefit of CVVH in survival or clinical outcomes, such as RRT dependence, organ dysfunction, or vasopressor use, and instead, it led to shorter filter life (82).…”

Section: Rrt Modality Optionsmentioning

confidence: 99%

A Patient with AKI after Cardiac Surgery

Tolwani¹

2014

Clinical Journal of the American Society of Nephrology

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Up to 30% of patients undergoing cardiac surgery develop AKI, with 1% requiring RRT. AKI is an independent risk factor for morbidity and mortality. Postoperatively, even minimal changes in serum creatinine are associated with a substantial increase in mortality. No intervention has been definitely proven effective in reducing kidney injury. The successful prevention and management of AKI involves identifying patients at risk for AKI, recognizing subtle abnormalities in a timely manner, performing basic clinical assessments, and responding appropriately to data obtained. With that in mind, in this Attending Rounds, a woman with AKI in the setting of cardiac surgery is presented to highlight the use of history, physical exam, hemodynamic monitoring, laboratory data trends, and urine indices in establishing the correct diagnosis and appropriate management.

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Effect of hemofiltration on hemodynamics and systemic concentrations of anaphylatoxins and cytokines in human sepsis

Cited by 95 publications

References 43 publications

Techniques of extracorporeal cytokine removal: a systematic review of human studies

Techniques of extracorporeal cytokine removal: a systematic review of human studies

High versus standard-volume haemofiltration in hyperdynamic porcine peritonitis: effects beyond haemodynamics?

A Patient with AKI after Cardiac Surgery

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