Continuous Hemodiafiltration with Cytokine-Adsorbing Hemofilter in the Treatment of Severe Sepsis and Septic Shock

Abstract

Continuous hemodiafiltration (CHDF) using a polymethymethacrylate (PMMA) membrane hemofilter (PMMA-CHDF) can effectively and continuously remove various cytokines from the circulating blood. PMMA-CHDF can decrease the blood levels of various cytokines when the blood levels of cytokines are high prior to the initiation of CHDF. The main mechanism of cytokine removal with PMMA-CHDF is the adsorption of cytokines to the hemofilter membrane and this characteristic was not observed in the other membrane material. PMMA-CHDF could improve blood pressure, the depressed monocytic HLA-DR expression, and recover the delayed neutrophil apoptosis in septic patients. Thus, cytokine removal with PMMA-CHDF would be effective for the treatment of severe sepsis and septic shock.

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

“…Such effects were not obtained when other available membrane hemofilters at that time, such as polysulfone (PS), polyacrylonitrile (PAN), ethylene vinyl alcohol (EVAL), and cellulose triacetate (CTA) were used. We therefore started to investigate removal of mediators by CHDF [11] and reported the clinical efficacy of PMMA-CHDF [12][13][14].…”

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

“…The idea of improving a patient’s clinical condition by removing excessive cytokines from circulating blood through continuous renal replacement therapies (CRRT) such as continuous hemofiltration and continuous hemodiafiltration has been challenged for the last two decades [1,2,3]. Past opinions asserting that cytokines could not be removed effectively from the bloodstream with CRRT [4] have been expressed.…”

“…In addition, we previously reported that it is feasible to continuously remove cytokines from the bloodstream based on the principle of adsorption by performing continuous hemodiafiltration using a polymethyl methacrylate (PMMA) membrane hemofilter. Such a reduction in cytokine blood concentrations may contribute to the prevention and treatment of organ damage and to recovery from septic shock [2,8,9,10]. …”

Extracorporeal blood purification for sepsis

“…Both have a high cytokine adsorption capacity but surface treatment can further modify their haemoadsorptive properties. [45][46][47] oXiris haemofilter oXiris (Gambro Hospal, Stockholm, Sweden) is an AN69-based membrane haemofilter that is surfacetreated with a polyethyleneimine and grafted with heparin ( Table 2). The AN69 core membrane has superior cytokine-binding capacity compared with the traditional polysulphone membrane.…”