Intermittent High-Permeability Hemofiltration Modulates Inflammatory Response in Septic Patients with Multiorgan Failure

Abstract

Background/Aim: Continuous venovenous hemofiltration with high-permeability hemofilters is a novel approach in the adjuvant therapy of septic patients. High-permeability hemofilters are characterized by an increased pore size which facilitates the filtration of inflammatory mediators. The present study examines whether intermittent high-permeability hemofiltration has an immunomodulatory effect on polymorphonuclear leukocytes and mononuclear cells. Methods: Twenty-eight septic patients with acute renal failure were randomly allocated to either receive intermittent high-permeability or conventional hemofiltration. Intermittent high-permeability hemofiltration consisted of a daily 12-hour course of high-permeability hemofiltration alternated by conventional hemofiltration. For high-permeability hemofiltration, a newly developed high-flux polyamide membrane (P2SH) with a nominal cutoff point of 60 kD was used. For conventional hemofiltration a high-flux polyamide hemofilter (Polyflux 11S, cutoff point 30 kD) was used. Results: The polymorphonuclear leukocyte phagocytosis activity before starting hemofiltration was almost double the rate of healthy controls in both groups (p < 0.001). The phagocytosis rate decreased significantly during the course of intermittent high-permeability hemofiltration (p < 0.05), whereas the values remained unchanged in the conventional hemofiltration group. Incubation of high-permeability filtrates with blood from healthy donors resulted in a significant induction of phagocytosis (p < 0.001), whereas conventional filtrates had no phagocytosis-stimulating effects. In addition, incubation of healthy-donor mononuclear cells with high-permeability but not conventional filtrates resulted in a significant tumor necrosis factor alpha release (p < 0.001). Conclusions: Intermittent high-permeability hemofiltration is a novel extracorporeal elimination modality which exhibits immunomodulatory effects on leukocytes, attenuating polymorphonuclear neutrophil phagocytosis. Further studies are necessary to elucidate whether these effects translate in a clinical improvement in patients suffering from sepsis.

Albumin Loss and Citrate Load in Pre-Dilution High Cut-Off-CVVHDF with Regional Citrate (18 mmol/L) and High Cut-Off CVVHD with Systemic Heparin: An in vitro Study

“…On the other hand, the same persistency of high levels of transmembrane clearance might be expected for other large solutes as cytokines, that is, the target solutes of this extracorporeal blood purification therapy. The slight difference between the 12-h albumin loss observed in our study and in the study by Morgera et al [26] could derive from the larger membrane used in our protocol (1.1 vs. 0.6 m 2 ) and from the higher albumin concentration observed in our experimental solution (the patient solution ) than the one observed in plasma of patients enrolled by Morgera et al [26] (3 vs. 2.5 g/dL).…”

“…In a prospective randomized trial on 16 septic patients with AKI, Morgera et al [26] measured an albumin transmembrane loss of 1.14 g (Interquartile range [IQR] 0.65–1.92 g) in the first 30 min of a convective treatment performed with blood and replacement flows of 150 mL/min and 1,000 mL/h respectively. Although slightly higher, the albumin loss observed in our study is consistent with respect to the one obtained by Morgera et al [26]; in particular, an albumin transmembrane loss of 2.01–2.06 g (measured with lines and bags methods) was observed in first 30 min of the protocol (the single pass phase).…”

“…Nevertheless, Morgera et al [26] reported an albumin transmembrane loss of 4.82 g (IQR 2.6–8.6 g) over 12 h of convective treatment. In our study, an albumin transmembrane loss of 2.52–2.8 g (measured with lines and bags methods) was measured over 3 h of the recirculation phase.…”

Cytokine Removal with High Cut-Off Membrane: Review of Literature

“…At the end, 3 case reports [15,16,17], 3 studies on animals [18,19,20], 11 in-vitro/ex-vivo studies [13,21,22,23,24,25,26,27,28,29,30,] and 6 randomized clinical trials/observational studies [14,31,32,33,34,35] fulfilled optimum criteria. The main results deriving from this pool constitute this review.…”

Pilot study on the effects of high cutoff hemofiltration on the need for norepinephrine in septic patients with acute renal failure*

“…We recently showed that high cutoff hemofiltration can be safely applied in critically ill patients (14). We also showed that polymorphonuclear leukocyte function and lymphocyte proliferation are positively influenced by this new procedure (19,20).…”