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

Morgera, Stanislao; Haase, Michael; Kuss, Thomas; Vargas-Hein, Ortrud; Zuckermann-Becker, Heidrun; Melzer, Christoph; Krieg, H; Wegner, Brigitte; Bellomo, Rinaldo; Neumayer, Hans H.

doi:10.1097/01.ccm.0000229147.50592.f9

Cited by 176 publications

(118 citation statements)

References 35 publications

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“…In experimental models of sepsis, HCO membranes improve hemodynamics and prolong survival [71]. In patients with sepsis-induced acute kidney injury, Morgera and colleagues [72] reported a reduction in vasopressor requirements with the use of HCO hemofiltration and not with conventional CVVH. Additionally, cytokine clearance rates were significantly higher in the HCO hemofiltration group.…”

Section: High-adsorption Hemofiltration and High-cutoff Membranesmentioning

confidence: 99%

Clinical review: Blood purification for sepsis

2011

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Sepsis is the primary cause of death in the intensive care unit. Extracorporeal blood purification therapies have been proposed for patients with sepsis in order to improve outcomes since these therapies can alter the host inflammatory response by non-selective removal of inflammatory mediators or bacterial products or both. Recent technological progress has increased the number of techniques available for blood purification and their performance. In this overview, we report on the latest advances in blood purification for sepsis and how they relate to current concepts of disease, and we review the current evidence for high-volume hemofiltration, cascade hemofiltration, hemoadsorption, coupled plasma filtration adsorption, high-adsorption hemofiltration, and high-cutoff hemofiltration/hemodialysis. Promising results have been reported with all of these blood purification therapies, showing that they are well tolerated, effective in clearing inflammatory mediators or bacterial toxins (or both) from the plasma, and efficacious for improvement of various physiologic outcomes (for example, hemodynamics and oxygenation). However, numerous questions, including the timing, duration, and frequency of these therapies in the clinical setting, remain unanswered. Large multicenter trials evaluating the ability of these therapies to improve clinical outcomes (that is, mortality or organ failure), rather than surrogate markers such as plasma mediator clearance or transient improvement in physiologic variables, are required to define the precise role of blood purification in the management of sepsis.

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Section: High-adsorption Hemofiltration and High-cutoff Membranesmentioning

confidence: 99%

Clinical review: Blood purification for sepsis

2011

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“…Its ability to remove cytokines in ex vivo and in vivo studies has now been shown to be greater than that of any other technology so far (120) and has increased survival in experimental models of sepsis (121). HCO therapy seems to have beneficial effects on immune cell function (122), and preliminary human studies using intermittent hemodialysis with HCO membranes have confirmed its ability to remove marker cytokines IL-6 and IL-1 receptor antagonist, with a decreased dosage of norepinephrine in patients with sepsis (123). HCO membrane-based EBP has now been applied in at least four clinical studies and to the treatment of Ͼ70 patients with septic AKI with no reports of serious adverse effects.…”

Section: Different Purification Technologies and Their Evaluation In mentioning

confidence: 99%

Potential Interventions in Sepsis-Related Acute Kidney Injury

Ronco¹,

Kellum²,

Bellomo³

et al. 2008

Clinical Journal of the American Society of Nephrology

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Sepsis is an important cause of morbidity and mortality. Acute kidney injury often complicates sepsis, leading to greater complexity, cost of care, and worsening prognosis. In recent years, a consensus definition of acute kidney injury has been developed, facilitating research into the pathophysiology and epidemiology of this disorder. New and emerging biomarkers to recognize kidney injury before functional abnormalities are manifest may allow early recognition and facilitate prevention or treatment. Furthermore, advances in the clinical management of sepsis may have secondary benefits with respect to renal outcomes. Existing and hybrid extracorporeal therapies are being investigated not only as means to replace lost kidney function but also to modulate the immune response to sepsis. For those who have more advanced forms of kidney injury, strategies to promote renal recovery are being sought to minimize the long-term consequences of impaired kidney function. This review provides an update on the current state of the science and a glimpse toward the future of intervention in sepsis-related acute kidney injury.

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“…Finally, the beneficial effects observed with hemofiltration it may be not necessarily attributed to the removal of inflammatory mediators. Some of these findings may be explained by reduced temperature, handling of the water balance (reducing the water extravascular lung or optimizing the Starling curve of patients) or metabolic changes (as may be the correction of acidosis), which increases the effect of catecholamines (5,6,15,96,97).…”

Section: Discussionmentioning

confidence: 99%

“…In addition to being better tolerated hemodynamically, CRRT is also as efficient in removing solutes over the course of 24 to 48 hours as conventional hemodialysis. Although the clearance rate of small solutes (such as urea) is slower per unit time with CRRT (17 mL/min with CAVHD versus more than 160 mL/min with hemodialysis), the rates are closer at 24 hours and more urea is removed over 48 hours with CRRT than with a single run of hemodialysis (13)(14)(15)(16)(17)(18).…”

mentioning

confidence: 99%

Continuous Renal Replacement Therapies in Patients with Severe Sepsis and Septic Shock

García-Miguel¹

2012

Sepsis - An Ongoing and Significant Challenge

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

Cited by 176 publications

References 35 publications

Clinical review: Blood purification for sepsis

Clinical review: Blood purification for sepsis

Potential Interventions in Sepsis-Related Acute Kidney Injury

Continuous Renal Replacement Therapies in Patients with Severe Sepsis and Septic Shock

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