Comparison of Interleukin-6 Removal Properties among Hemofilters Consisting of Varying Membrane Materials and Surface Areas: An in vitro Study

Hirayama, Yo; Oda, Shigeto; Wakabayashi, Kiyohito; Sadahiro, Tomohito; Nakamura, Masataka; Watanabe, Eizo; Tateishi, Yohei

doi:10.1159/000321142

Cited by 28 publications

(19 citation statements)

References 38 publications

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“…Results demonstrated that when three different membrane materials (PMMA, CTA, and PS) were compared, the IL-6 removal rate for the PMMA membrane hemofilter was by far greater than that for other membrane hemofilters and IL-6 was scarcely detectable in the filtrate. When a CTA or a PS membrane hemofilter was used, IL-6 could be removed only at an efficiency lower than that with a PMMA membrane hemofilter and IL-6 was detected in the filtrate [32]. Furthermore, when direct perfusion of ascites containing high IL-6 levels was performed with these membrane hemofilters, a CTA membrane hemofilter removed only 20 % of IL-6, whereas a PMMA membrane filter removed almost 100 % of IL-6 after 3-h perfusion [32].…”

Section: Pmma Hemofiltermentioning

confidence: 99%

“…When a CTA or a PS membrane hemofilter was used, IL-6 could be removed only at an efficiency lower than that with a PMMA membrane hemofilter and IL-6 was detected in the filtrate [32]. Furthermore, when direct perfusion of ascites containing high IL-6 levels was performed with these membrane hemofilters, a CTA membrane hemofilter removed only 20 % of IL-6, whereas a PMMA membrane filter removed almost 100 % of IL-6 after 3-h perfusion [32]. These results prove that the PMMA membrane adsorbed IL-6 at a high efficiency.…”

Section: Pmma Hemofiltermentioning

confidence: 99%

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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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Section: Pmma Hemofiltermentioning

confidence: 99%

Section: Pmma Hemofiltermentioning

confidence: 99%

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

Hattori

Oda

2016

Ren Replace Ther

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“…We have studied the efficacy of CVVHDF with a poly(methyl methacrylate) (PMMA) membrane hemofilter which has potent cytokine-adsorbing capacity as cytokine remover [8,19]. Hirayama et al [21] compared IL-6 removal among different membranes and found that PMMA is superior compared to cellulose acetate and polysulfone membranes. Furthermore, Matsuda et al [22] investigated the clinical study on the comparison of efficacy between continuous hemodiafiltration (CHDF) with a PMMA hemofilter which has cytokine-adsorbing capacity and CHDF with a polyacrylonitrile hemofilter which does not have cytokine-adsorbing capacity and they found that patients with sepsis treated with PMMA-CHDF showed better hemodynamic condition, better urinary output and more importantly better survival compared to the patients treated with PAN-CHDF [22].…”

Section: Countermeasures Against Hypercytokinemiamentioning

confidence: 99%

Continuous Hemodiafiltration with a Cytokine-Adsorbing Hemofilter for Sepsis

et al. 2012

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Since the introduction of the new pathophysiological concept of pathogen-associated molecular patterns (PAMPS) and alarmins, endotoxin has been recognized as only one of the PAMPS. It is widely accepted that hypercytokinemia plays a pivotal role in the pathophysiology of sepsis. Many kinds of blood purification modalities have been proposed as a therapeutic tool against sepsis, including high-volume continuous hemofiltration whose efficacy has recently been questioned. We report that continuous hemodiafiltration (CHDF) with a cytokine-adsorbing hemofilter (CAH), such as polymethyl methacrylate hemofilter and AN69ST hemofilter (CAH-CHDF), can remove many kinds of cytokines and has been very effective in the treatment of severe sepsis and septic shock. Based on the understanding of the recent pathophysiology, we suggest that CAH-CHDF is an alternate therapy to direct hemoperfusion with endotoxin-adsorbing column in the treatment of sepsis.

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“…However, our study did not show any significant differences in filter longevity, bleeding complications, or need for blood transfusions [23–26]. Furthermore, there was visible clot formation in almost all haemodiafiltration circuit components, including the venous bubble-trap chamber and the arterial and the venous lines, suggesting that the overall filtrating system surface, not the filter only, can induce repetitive clotting [26].…”

Section: Discussionmentioning

confidence: 92%

Platelet Consumption and Filter Clotting Using Two Different Membrane Sizes during Continuous Venovenous Haemodiafiltration in the Intensive Care Unit

Tempesta

Rudiger

Previsdomini

et al. 2014

Critical Care Research and Practice

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Background. The aim of this study was to investigate whether different haemofilter surface areas affect clotting and platelet consumption in critically ill patients undergoing continuous venovenous haemodiafiltration (CVVHDF). Methods. CVVHDF was performed in postdilution technique using a capillary haemofilter with two different membrane sizes, Ultraflux AV 1000S (n = 17, surface 1.8 m2, volume 130 mL), and the smaller AV 600S (n = 16, surface 1.4 m2, volume 100 mL), respectively. Anticoagulation was performed with heparin. Results. No significant differences were found when the two filters were compared. CVVHDF was performed for 33 (7–128) hours with the filter AV 1000S and 39 (7–97) hours with AV 600S (P = 0.68). Two (1–4) filters were utilised in both groups over this observation period (P = 0.94). Platelets dropped by 52,000 (0–212,000) in AV 1000S group and by 89,500 (0–258,000) in AV 600S group (P = 0.64). Haemoglobin decreased by 1.2 (0–2.8) g/dL in AV 1000S group and by 1.65 (0–3.9) g/dL in AV 600S group (P = 0.51), leading to the transfusion of 1 (0–4) unit of blood in 19 patients (10 patients with AV 1000S and 9 with AV 600S). Filter observation was abandoned due to death (12.1%), need for systemic anticoagulation (12.1%), repeated clotting (36.4%), and recovery of renal function (39.4%). Conclusion. Our study showed that a larger filter surface area did neither reduce the severity of thrombocytopenia and anaemia, nor decrease the frequency of clotting events.

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Comparison of Interleukin-6 Removal Properties among Hemofilters Consisting of Varying Membrane Materials and Surface Areas: An in vitro Study

Cited by 28 publications

References 38 publications

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

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

Continuous Hemodiafiltration with a Cytokine-Adsorbing Hemofilter for Sepsis

Platelet Consumption and Filter Clotting Using Two Different Membrane Sizes during Continuous Venovenous Haemodiafiltration in the Intensive Care Unit

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