Hemofiltration increases IL-6 clearance in early systemic inflammatory response syndrome but does not alter IL-6 and TNFα plasma concentrations

Sander, Andreas; Armbruster, W; Sander, Birgitta; Daul, A; Länge, R.; Peters, Jürgen

doi:10.1007/s001340050425

Cited by 125 publications

(76 citation statements)

References 20 publications

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“…This theory has been called "the peak concentration hypothesis" (6). However, the most frequently used membranes have a cut off between 30 and 40 kDa and induce no sufficient cytokines clearance (7)(8)(9)(10). For example, the convective clearance of IL-6, one of the most important pro-inflammatory cytokines (11), is less than 2 ml/min with such membranes and an ultrafiltrate rate of 1 l/h (which corresponds to a sieving coefficient (SC) of 0.12) (9).…”

Section: Introductionmentioning

confidence: 99%

Confirmation of High Cytokine Clearance by Hemofiltration with a Cellulose Triacetate Membrane with Large Pores: An in vivo Study

et al. 2006

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Abstract:Objective: To confirm in vivo the hypothesis that hemofiltration with a large pore membrane can achieve significant cytokine clearance. Method: We used a well-known animal model of endotoxinic shock (0.5 mg/kg of lipopolysaccharide from Escherichia Coli over a period of 30 mins). Six pigs were hemofiltrated for 3 hours with a large pore membrane (78 Å pore, 80 kDa cut off) (Sureflux FH 70, Nipro, Osaka, Japan). The ultrafiltration rate was 45 ml/kg/min. Samples were taken from arterial, venous line and in the ultrafiltrate at T120 and T240. We measured concentrations of interleukin 6, interleukin 10 and albumin. Results: At T120 and T240, the IL-6 clearances were 22 ± 7 and 15 ± 3 ml/min, respectively. The IL-6 sieving coefficients were 0.97 and 0.7 at T120 and T240, respectively. At T120 and T240, the IL-10 clearances were 14 ± 4 and 10 ± 7 ml/min, respectively The sieving coefficients were 0.63 and 0.45 at T120 and T240, respectively. The concentrations of IL-6 and IL-10 were the same at T0 and T240. At T60 and T240, the plasmatic albumin concentrations were 24 ± 4 g/L and 23 ± 4 g/L, respectively (p = 0.13). Conclusions: In this animal model of endotoxinic shock, we confirm the high cytokine clearance observed when hemofiltration is applied to a large pore membrane. The loss of albumin seems negligible. The impact of such clearances on hemodynamic stability and survival remains to be proved.

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Section: Introductionmentioning

confidence: 99%

Confirmation of High Cytokine Clearance by Hemofiltration with a Cellulose Triacetate Membrane with Large Pores: An in vivo Study

et al. 2006

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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%

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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“…However, a decrease in the plasma concentration during CRRT is more an exception than the rule, possibly due to the ongoing production and the high endogenous clearance limiting the contribution of extracorporeal elimination. Two recent controlled clinical studies did not establish an effect of hemofiltration on the plasma concentrations of TNF-(and interleukin-6 (Il-6) 16,17 . The use of high volume hemofiltration might increase the contribution of extracorporeal clearance, whereas frequent filter changes might increase the elimination of mediators adsorbing to the membrane.…”

Section: Sepsis and Other Inflammatory Syndromesmentioning

confidence: 99%

Continuous Renal Replacement Therapy

Amlani¹

2016

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SUMMARY -Acute renal failure (ARF) is currently more frequently seen as part of a more complex syndrome defined by sepsis and/or multiple organ failure. Evolution in the field of hemodialysis has led to a parallel development of new systems for continuous renal replacement therapy (CRRT) in critically ill patients. The various CRRT modalities differ in the type of vascular access, application of diffusive or convective clearance (or a combination of both), and location where the replacement fluid enters the circuit. CRRTs have certainly facilitated the management of critically ill patients with ARF combined with cardiovascular instability, severe fluid overload, hypercatabolism, cerebral edema, adult respiratory distress syndrome, lactic acidosis, sepsis or other inflammatory syndromes, crush syndrome, congestive heart failure, and cardiopulmonary bypass. Continuous therapies incorporate several advantages including improved hemodynamic stability, optimal fluid balance, gradual urea removal, elimination of septic mediators, and the possibility of unlimited parenteral nutrition. Major difficulties and unsolved problems of CRRT are the ongoing necessity for continuous anticoagulation, considerable loss of amino acids, vitamins, trace elements, potassium, phosphate, and some drugs as well as immobilization of the patient. The advantages of CRRT should theoretically translate into improved outcomes of critically ill ARF patients, but the superiority of continuous modalities in terms of outcomes is still controversial, despite encouraging results in some clinical trials.

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Hemofiltration increases IL-6 clearance in early systemic inflammatory response syndrome but does not alter IL-6 and TNFα plasma concentrations

Cited by 125 publications

References 20 publications

Confirmation of High Cytokine Clearance by Hemofiltration with a Cellulose Triacetate Membrane with Large Pores: An in vivo Study

Confirmation of High Cytokine Clearance by Hemofiltration with a Cellulose Triacetate Membrane with Large Pores: An in vivo Study

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

Continuous Renal Replacement Therapy

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