Cytokines in Plasma and Ultrafiltrate during Continuous Arteriovenous Haemofiltration

Abstract

Cytokines are considered to be important mediators in the pathophysiology of sepsis and septic shock. We investigated if continuous arteriovenous haemofiltration (CAVH) could be used to remove excessive amounts of the cytokines tumour necrosis factor-ex (TNFex), interleukin (/L)-Iex and /L-6 from peripheral blood in critically ill patients. Nine septic patients with renal failure were treated with CAVH. Ultrafittrate and plasma were tested for cytokines by ELISA. All patients had detectable TNFex and IL-6 plasma levels, ranging from /0-750 pg/ml and 50-4,575 pg/ml, respectively. TNFex was removed by the ultrafittrate with concentrations ranging from /0-1,000 pg/ml. The TNFex levels were significantly higher in the ultrafittrate samples than in the corresponding plasma samples (P< 0.003). IL-6 was undetectable in the ultra filtrate from five of the patients despite concomitant high plasma levels. IL-J ex was detectable in both plasma and ultra filtrate in four patients. All patients developed multi-organ faiture and septic shock and seven died. It is concluded that TNFex and /L-Jex but not /L-6 can be removed by CAVH in patients with sepsis.

The Effect of Intensive Plasma Water Exchange by Hemofiltration on Hemodynamics and Soluble Mediators in Canine Endotoxemia

“…CVVH is a technique of hemofiltration that is based on the principle of convective plasma water exchange. CVVH has been shown to clear some of the putative mediators of sepsis (19,20) and to affect circulating levels of TNF-␣ (12). In several animal models of sepsis, it has achieved beneficial effects on cardiac performance and pulmonary function (21,22).…”

Concurrent centrifugation plasmapheresis and continuous venovenous hemodiafiltration

“…To our knowledge, this is the first report of concurrent centrifugation plasmapheresis and CVVHD. The use of combined plasmapheresis and CVVH/D therapy is beneficial by virtue of the removal of large molecular weight proteins, including antibodies, free hemoglobin, free methemoglobin, von Willebrand factor multimers, and circulating immune complexes; and smaller molecules (<40-42 kilodaltons) including urea, creatinine, middle molecules, cytokines [7,12,13], tumor necrosis factor [14][15][16], endotoxin [17], and other septic toxins [18]. It is important to remember that removal of a wide range of molecules with P-CVVHD may also necessitate significant adjustments in drug dosing.…”

Cytokine removal and cardiovascular hemodynamics in septic patients with continuous venovenous hemofiltration

“…Recent studies have demonstrated significant removal rates of inflammatory cytokines from the circulation of septic patients by continuous renal replacement therapies [3,8]. Millar et al [25], in a prospective randomized trial, studied the effect of hemofiltration on plasma levels of TNFa, IL8, and IL6 in 18 children following cardiopulmonary bypass.…”

“…Continuous renal replacement therapies have been shown to improve cardiovascular hemodynamics in these patients, and it has been postulated that removable myocardial depressant factors are present in the blood [6,7]. Recent studies suggested that continuous renal replacement therapies remove cytokines from the serum of septic, critically ill patients [3,8]. There is considerable evidence that the elimination of cytokines is due to the molecular weight of the cytokine and the cut-off point of the membrane.…”