Comparison of the circulatory effects of continuous renal replacement therapy using AN69ST and polysulfone membranes in septic shock patients: A retrospective observational study

Abstract

The acrylonitrile‐co‐methallyl sulfonate surface‐treated (AN69ST) membrane is expected to improve hemodynamics in patients with sepsis through cytokine adsorption. However, the clinical literature on AN69ST membranes is very limited. We aimed to compare the circulatory effects of continuous renal replacement therapy (CRRT) between patients using the AN69ST membrane and polysulfone (PS) membrane (a nonadsorbing membrane). This retrospective observational study enrolled 38 patients with septic shock, as defined by Sepsis‐3 criteria, who required CRRT from April 2013 to March 2018. Those who died within 24 hours after CRRT initiation and received polymyxin B‐immobilized fiber column direct hemoperfusion, extracorporeal membrane oxygenation, and CRRT using other membranes were excluded. The primary outcome was the vasopressor dependency index during the 12 hours after CRRT initiation, which was calculated as (inotropic score)/(mean arterial pressure). Of 38 patients analyzed, 16 underwent CRRT with an AN69ST membrane and 22 with a PS membrane. The median patient age was 68 years, and the median Acute Physiology and Chronic Health Evaluation (APACHE) II score at intensive care unit admission was 29.5. The vasopressor dependency index decreased significantly during the 12 hours after CRRT initiation in both groups (AN69ST: from 0.50 ± 0.43 to 0.33 ± 0.27 [P < .05], PS: from 0.34 ± 0.30 to 0.21 ± 0.22 [P < .05]). The time course of the vasopressor dependency index during the 12 hours did not differ between the two groups (P = .11). The vasopressor dependency index decreased significantly after CRRT initiation in both groups. The time course of the vasopressor dependency index did not differ between the groups.

Use of CytoSorb© Hemoadsorption in Patients on Veno-Venous ECMO Support for Severe Acute Respiratory Distress Syndrome: A Systematic Review

“…Of these, 22 were excluded due to their focus on veno-arterial ECMO (V-A ECMO) or extracorporeal cardiopulmonary resuscitation (ECPR) [ 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. Fourteen studies were excluded for lack or scarcity of data on CytoSorb© use [ 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 ], four because of the lack of specific data for the ECMO subgroup [ 67 , 68 , 69 , 70 ], four because CytoSorb© was not used concomitantly with ECMO therapy [ 71 , 72 , 73 , 74 ], two because outcomes of interest for the simultaneous use of CytoSorb© and ECMO were not reported [ 75 , 76 ], and one because it focused on a different device [ 77 ]. One study was excluded because it only reported preliminary findings from other articles [ 78 ].…”

Comparison of the cytokine adsorption ability in continuous renal replacement therapy using polyethyleneimine-coated or polymethylmethacrylate hemofilters: a pilot single-center open-label randomized control trial

“…Some observational studies [33][34][35] have shown that AN69ST hemo lters are superior to non-AN69ST hemo lters. Furthermore, AN69ST and PMMA membranes have already been widely used in Japan [33][34][35][36][37], and no serious adverse events were observed in either group. Therefore, future RCTs are warranted to investigate the effect of AN69ST and PMMA hemo lters on clinical outcomes.…”

Comparison of the cytokine adsorption ability in continuous renal replacement therapy using polyethyleneimine-coated polyacrylonitrile (AN69ST) or polymethylmethacrylate (PMMA) hemofilters: a pilot single-center open-label randomized control trial

“…Some observational studies [ 33 – 35 ] have shown that AN69ST hemofilters are superior to non-AN69ST hemofilters. Furthermore, AN69ST and PMMA membranes have already been widely used in Japan [ 33 – 37 ], and no serious adverse events were observed in either group. Therefore, future RCTs are warranted to investigate the effect of AN69ST and PMMA hemofilters on clinical outcomes.…”