High Cut-off Membranes in Acute Kidney Injury and Continuous Renal Replacement Therapy

Abstract

Innovation in continuous renal replacement therapies (CRRT) utilized to treat acute kidney injury (AKI) and sepsis, has brought new machines and techniques. Part of these new advances are due to the availability of innovative biomaterials and the construction of membranes with larger pores and wide distribution of pore sizes. This includes the creation of a new generation of high cut-off membranes whose utilization in clinical practice is promising for the wide spectrum of solutes that are removed during extracorporeal therapies.However, the enlargement of pore diameters brings some loss of albumin during treatment and this effect is still under evaluation, since there is a possibility that this is detrimental for the patient. A thorough review of the available clinical literature is reported in this paper with a reappraisal of the potential application of these new technologies.

Methods of Extracorporeal Hemocorrection in Sepsis (Review)

“…Мембраны с высокой точкой отсечки (high cutoff membranes -HCOM) характеризуются увеличенным диаметром пор. Данная техническая особенность позволяет повысить проницаемость до точки отсечки в 100 кДа [34]. HCOM, используемые при ЗПТ, продемонстрировали более высокие показатели клиренса некоторых медиаторов воспаления по сравнению со стандартной мембраной [35].…”

How Does Continuous Renal Replacement Therapy Affect Septic Acute Kidney Injury?

“…However, certain clinical research declared that the concentration of plasma cytokines makes no difference during CRRT, though some cytokines can be detected in the filtrate fluid [24]. Therapies such as high-volume hemofiltration or high cut-off membrane may increase the clearance of inflammatory cytokines, but whether this will benefit the patients is still unknown [22, 26]. Furthermore, no consensus has been performed about which kind of EBP techniques or membrane is able to most benefit the critically ill patients.…”