Complement depletion during haemofiltration with polyacrilonitrile membranes

Gasche, Y.; Pascual, Manuel; Suter, Peter M.; Favre, H.; Chevrolet, J.-C.; Schifferli, Jürg A.

doi:10.1093/oxfordjournals.ndt.a027024

Cited by 48 publications

(22 citation statements)

References 6 publications

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“…Gasche et al performed CVVH using an AN69 membrane hemofilter (AN69-CVVH) in seven patients and reported removal of factor D (activating complement) by adsorption [36]. De Vriese et al performed AN69-CVVH in 15 patients with septic AKI and reported a rapid decrease in blood cytokine levels and improvement in cardiac output, pulmonary artery wedge pressure, and systemic vascular resistance [37].…”

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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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%

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

Hattori

Oda

2016

Ren Replace Ther

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“…58] have shown that synthetic filters in common use in hemofiltration can extract nearly every substance involved in sepsis to a certain degree. Prominent examples are complement factors [59,60], TNF, IL-1, IL-6 [60][61][62][63], IL-8 [64] and platelet-activating factor [65,66]. Regarding plasma cytokine levels, their decrease appeared nevertheless of minor degree.…”

Section: Crrtmentioning

confidence: 99%

Extracorporeal Therapies in Non-Renal Disease: Treatment of Sepsis and the Peak Concentration Hypothesis

et al. 2004

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In the setting of intensive care, patients with acute renal failure often present a clinical picture of the systemic inflammatory response syndrome (SIRS). SIRS can be caused by bacterial stimuli or by non-microbiological stimuli that induce a significant inflammatory response. When this response is exaggerated, the patient experiences multiple organ system failure and a condition of sepsis also defined as a systemic malignant inflammation. This is mostly characterized by an invasion of cytokines and other pro-inflammatory mediators into the systemic circulation where major biological effects take place, including vasopermeabilization, hypotension and shock. At the same time, the monocyte of the septic patient seems to be hyporesponsive to inflammatory stimuli to a certain extent. In this condition, the patient faces a situation of hyperinflammation but at the same time of immunodepression expressing a clinical entity defined as counter anti-inflammatory response syndrome. The general picture of the clinical disorder is therefore better characterized by an immunodysregulation than by a simple pro- or anti-inflammatory disorder. Due to the short half-life of cytokines and other mediators spilled over into the circulation, it is extremely difficult to approach the problem at the right moment with the right pharmacological agent. For these reasons, the peak concentration hypothesis suggests that continuous renal replacement therapies, due to their continuity and unspecific capacity of removal, might be beneficial in cutting the peaks of the concentrations of both pro- and anti-inflammatory mediators, restoring a situation of immunohomeostasis. Thus the patient may benefit from a lesser degree of immunodysregulation and he/she may restore a close-to-normal capacity of response to exogenous stimuli.

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“…From several animal and human investigations we know that our ability to remove middle molecules (especially those 15,000 in molecular weight such as cytokines and complement components) is limited when using current technology [13]. Convective extraction is probably better than diffusive removal, but still small in amount and unlikely to have a biological or clinical impact [14].…”

Section: What Can Current Extracorporeal Blood Purification Therapiesmentioning

confidence: 99%

Blood Purification in Non-Renal Critical Illness

et al. 2003

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Extracorporeal therapies designed to remove substances from the circulation now include hemodialysis, hemofiltration, hemoadsorption, plasma filtration, cell-based therapies and combinations of any of the above. In recent years, there have been considerable advances in our understanding and technical capabilities, but consensus over the optimal way, and under what conditions to use these therapies does not exist. Consequently, we have initiated a series of conferences under the auspices of the Acute Dialysis Quality Initiative (ADQI). ADQI aims at establishing an evidence-based appraisal and set of consensus recommendations to standardize care and direct further research. The results of previous consensus conferences are available on-line at www.ADQI.net. ADQI conferences have focused on research and management of renal disease. However, extracorporeal therapies are being used or investigated in the management of many other disease processes including systemic inflammation, liver disease, cardiac disease and thrombotic diseases.

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Complement depletion during haemofiltration with polyacrilonitrile membranes

Cited by 48 publications

References 6 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

Extracorporeal Therapies in Non-Renal Disease: Treatment of Sepsis and the Peak Concentration Hypothesis

Blood Purification in Non-Renal Critical Illness

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