Application of endotoxin and cytokine adsorption haemofilter in septic acute kidney injury due to Gram-negative bacterial infection

Shum, Hoi‐Ping; Chan, Kenny K C; Kwan, M C; Yan, W W

doi:10.12809/hkmj133910

Cited by 63 publications

(84 citation statements)

References 18 publications

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“…However, opinion was split over the treatment of sepsis in patients without AKI. The potential ability of oXiris to control immunodepression and inflammation by capturing endotoxins and cytokines and for treating suspected Gramnegative infections was recognised by the participants, although they acknowledged that currently there is limited information published covering clinical experience with oXiris [15][16][17].…”

Section: Discussionmentioning

confidence: 99%

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Sepsis Management with a Blood Purification Membrane: European Experience

Pickkers¹,

Vassiliou

Liguts

et al. 2019

Blood Purif

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Background: Septic shock is a leading cause of acute kidney injury (AKI). Endotoxins and cytokine levels are associated with the occurrence and severity of AKI, and different blood purification devices are available to remove them from circulation. One such device, oXiris, is a hollow-fibre purification filter that clears both endotoxins and cytokines. Due to limited evidence, clinical use of this device is not currently advocated in guidelines. However, clinics do regularly use this device, and there is a critical need for guidance on the application of it in sepsis with and without AKI. Method: A modified Delphi-based method was used to collate European experts’ views on the indication(s), initiation and discontinuation criteria and success measures for oXiris. Results: A panel of 14 participants was selected based on known clinical expertise in the areas of critical care and sepsis management, as well as their experience of using the oXiris blood purification device. The participants used different criteria to initiate treatment with oXiris in sepsis patients with and without AKI. Septic shock with AKI was the priority patient population, with oXiris used to rapidly improve haemodynamic parameters. Achieving haemodynamic stability within 72 h was a key factor for determining treatment success. Conclusion: In the absence of established guidelines, users of hollow-fibre purification devices such as oXiris may benefit from standardised approaches to selecting patients and initiating and terminating treatment, as well as measuring success. Further evidence in the form of randomised clinical trials is urgently required.

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Section: Discussionmentioning

confidence: 99%

“…While there have been a handful of encouraging case reports [15][16][17], high-quality evidence is lacking concerning the effect of the oXiris device on clinical outcomes. Consequently, clinical use is currently not advocated [18].…”

Section: Introductionmentioning

confidence: 99%

Sepsis Management with a Blood Purification Membrane: European Experience

Pickkers¹,

Vassiliou

Liguts

et al. 2019

Blood Purif

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“…Their clinical parameters indicated the following severe clinical conditions: mean blood IL-6 level, 44,800 pg/mL; mean APACHE II score, 32.7; and mean blood lactate level, 69.0 mg/dL. The subjects of the oXiris®-CVVH study by Shum et al had a median APA-CHE II score of 36 (Table 1) [47]. Consequently, the selection of subjects based on actual measurements of humoral mediators such as IL-6 may be the key in clinical studies of CAH to be planned in the future.…”

Section: Future Perspectives Of Cah-chdfmentioning

confidence: 99%

“…Results demonstrated that the SOFA score after 48-h CVVH was reduced from the value at ICU admission by 38 % in the oXiris® group, while an increase of 3 % was observed in the control group. No significant difference was observed in ICU and in-hospital mortality between the two groups [47]. In Switzerland, an RCT that compares the efficacy of oXiris®-CVVH and PMX-DHP in patients with septic shock is currently in progress (ENDoX study).…”

Section: Modified An69st (Oxiris®)mentioning

confidence: 99%

Cytokine-adsorbing hemofilter: old but new modality for septic acute kidney injury

Hattori

Oda

2016

Ren Replace Ther

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While evidence supporting the hypothesis that blood purification improve outcome in septic acute kidney injury (AKI) has not been established, many physicians hope to improve outcome in septic AKI by blood purification. Elucidation of the pathophysiology of sepsis has revealed close involvement of humoral mediators, including cytokines, pathogen-associated molecular patterns, and alarmins, in the development of severe sepsis. Removal of substances by blood purification involves three major principles, namely filtration, dialysis (diffusion), and adsorption. Multiple large randomized controlled trials (RCTs) of high-volume hemofiltration (HVHF) for patients with AKI were conducted, but failed to prove the clinical efficacy of HVHF. Blood purification for the removal of mediators through dialysis and filtration using a high cutoff (HCO) membrane hemofilter has not also been established. Furthermore, a HCO membrane hemofilter shares a common problem with HVHF, which is excessive removal of useful substances, such as antimicrobial agents and/or nutrients. Accordingly, continuous hemodiafiltration using cytokine-adsorbing hemofilters (CAH-CHDF) such as polymethylmethacrylate (PMMA) and AN69ST membrane hemofilters has been attracting attention recently. In this review, we report recent findings regarding these old hemofilters with new applications. Although the number of in vitro and in vivo studies conducted to date has been limited, the studies suggest a possibility that these modalities are useful particularly for the treatment of septic shock and septic AKI. CAH-CHDF is expected to be recognized globally as a treatment of septic shock and septic AKI in the near future.

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“…Surface treatment with polyethyleneimine enhances endotoxin capture, 48 while heparin coating reduces membrane thrombogenicity, and prolongs the filter life and improves efficiency. A case-control study by Shum et al 49 involving Gram-negative septicaemic patients (n=6) showed that oXiris continuous venovenous haemofiltration (CVVH) was associated with a greater reduction in Sequential Organ Failure Assessment score compared with conventional polysulphone-based CVVH (n=24). Subsequent large case series (n=40) suggested that oXiris treatment had a positive effect on haemodynamics with a reduction in cytokine levels (IL-6).…”

Section: High-adsorption 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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Application of endotoxin and cytokine adsorption haemofilter in septic acute kidney injury due to Gram-negative bacterial infection

Abstract: The haemofilter membrane with enhanced endotoxin adsorption and cytokine removal capacity was a safe alternative to traditional polysulfone-based continuous venovenous haemofiltration and expedited improvement in organ dysfunction.

Cited by 63 publications

References 18 publications

Sepsis Management with a Blood Purification Membrane: European Experience

Sepsis Management with a Blood Purification Membrane: European Experience

Cytokine-adsorbing hemofilter: old but new modality for septic acute kidney injury

Extracorporeal blood purification for sepsis

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