Intermittent high permeability hemofiltration in septic patients with acute renal failure

Morgera, Stanislao; Rocktäschel, Jens; Haase, Michael; Lehmann, Christian; Heymann, Christian von; Ziemer, Sabine; Priem, Friedrich; Hocher, Berthold; Göhl, H.; Kox, Wolfgang J.; Buder, Hans-W.; Neumayer, Hans‐H.

doi:10.1007/s00134-003-2003-9

Cited by 84 publications

(67 citation statements)

References 21 publications

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“…Others have studied membranes with higher cut off values (around 100 kDa). Their results show high SC and clearances, but albumin loss becomes significant (13,14,16,(21)(22)(23). With the membrane used in our study, albumin loss is timely and quantitatively limited (17,20).…”

Section: Resultsmentioning

confidence: 82%

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: Resultsmentioning

confidence: 82%

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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“…Albumin SC for HCO techniques was reported in one paper and found to be 0.026. 16 Among the cytokines studied, the SC for TNF-alpha using HCO techniques appear to be consistently very low.…”

Section: Resultsmentioning

confidence: 95%

“…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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“…Albumin loss was comparable between HCO haemofiltration, HCO haemodialysis, and HCO haemodiafiltration. 66 Morgera et al 67 published the first study on the use of HCO haemofiltration among septic shock patients and showed good IL-6 (but not TNF-α) clearance. Subsequently, Morgera et al 68 conducted an RCT that involved 30 septic AKI patients who were randomised to HCO or conventional haemofiltration.…”

Section: High Cut-off Haemodialysis/ Haemofiltrationmentioning

confidence: 99%

Extracorporeal blood purification for sepsis

Shum

Chan

2016

Hong Kong Med J

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It has been speculated that extracorporeal blood purification therapies might improve the clinical outcome for patients with severe sepsis, with or without acute kidney injury, since the removal of inflammatory mediators and/or bacterial toxins from circulation could modulate the inflammatory responses that result in organ damage. Despite initial enthusiasm based on promising preliminary results, subsequent investigations did not show sustainable survival benefit. We review the principles and development of blood purification techniques for sepsis and septic acute kidney injury.

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Intermittent high permeability hemofiltration in septic patients with acute renal failure

Cited by 84 publications

References 21 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

Extracorporeal blood purification for sepsis

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