High permeability haemofiltration improves peripheral blood mononuclear cell proliferation in septic patients with acute renal failure

Morgera, Stanislao; Haase, Michael; Rocktäschel, Jens; Böhler, Torsten; Heymann, Christian von; Vargas-Hein, Ortrud; Krausch, Dietmar; Zuckermann-Becker, Heidrun; Müller, J. M.; Kox, Wolfgang J.; Neumayer, Hans H.

doi:10.1093/ndt/gfg435

Cited by 62 publications

(42 citation statements)

References 17 publications

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“…Others have studied membranes with higher cut off values (around 100 kDa). Their results show high SC and clearances, but albumin loss becomes significant (13,14,16,(21)(22)(23). With the membrane used in our study, albumin loss is timely and quantitatively limited (17,20).…”

Section: Resultsmentioning

confidence: 60%

“…Moreover, De Vriese et al and Heering et al measured no IL-10, one of the most important anti-inflammatory cytokines (12), in ultrafiltrate during CWH with such membranes (7,8). A cut off membrane of 40 kDa means a SC of 0.05 or 0.1 for a 40 kDa molecule (13,14). These results are obtained in vitro and these cut offs could be decreased by up to 40% when they are calculated in vivo (15).…”

Section: Introductionmentioning

confidence: 91%

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Confirmation of High Cytokine Clearance by Hemofiltration with a Cellulose Triacetate Membrane with Large Pores: An in vivo Study

et al. 2006

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Abstract:Objective: To confirm in vivo the hypothesis that hemofiltration with a large pore membrane can achieve significant cytokine clearance. Method: We used a well-known animal model of endotoxinic shock (0.5 mg/kg of lipopolysaccharide from Escherichia Coli over a period of 30 mins). Six pigs were hemofiltrated for 3 hours with a large pore membrane (78 Å pore, 80 kDa cut off) (Sureflux FH 70, Nipro, Osaka, Japan). The ultrafiltration rate was 45 ml/kg/min. Samples were taken from arterial, venous line and in the ultrafiltrate at T120 and T240. We measured concentrations of interleukin 6, interleukin 10 and albumin. Results: At T120 and T240, the IL-6 clearances were 22 ± 7 and 15 ± 3 ml/min, respectively. The IL-6 sieving coefficients were 0.97 and 0.7 at T120 and T240, respectively. At T120 and T240, the IL-10 clearances were 14 ± 4 and 10 ± 7 ml/min, respectively The sieving coefficients were 0.63 and 0.45 at T120 and T240, respectively. The concentrations of IL-6 and IL-10 were the same at T0 and T240. At T60 and T240, the plasmatic albumin concentrations were 24 ± 4 g/L and 23 ± 4 g/L, respectively (p = 0.13). Conclusions: In this animal model of endotoxinic shock, we confirm the high cytokine clearance observed when hemofiltration is applied to a large pore membrane. The loss of albumin seems negligible. The impact of such clearances on hemodynamic stability and survival remains to be proved.

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Section: Resultsmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 91%

Confirmation of High Cytokine Clearance by Hemofiltration with a Cellulose Triacetate Membrane with Large Pores: An in vivo Study

et al. 2006

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“…Previous studies showed the safe use of the Gambro HCO 1100 dialyzer in an intensive care setting (27,28). As predicted, we noted substantial albumin loss that required replacement on a regular basis (20 to 40 g per dialysis session and given as 20% human albumin solution).…”

Section: Discussionmentioning

confidence: 99%

Efficient Removal of Immunoglobulin Free Light Chains by Hemodialysis for Multiple Myeloma

Hutchison¹,

Cockwell²,

Reid³

et al. 2007

Journal of the American Society of Nephrology

234

140

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Of patients with newly diagnosed multiple myeloma, approximately 10% have dialysis-dependent acute renal failure, with cast nephropathy, caused by monoclonal free light chains (FLC). Of these, 80 to 90% require long-term renal replacement therapy. Early treatment by plasma exchange reduces serum FLC concentrations, but randomized, controlled trials have shown no evidence of renal recovery. This outcome can be explained by the low efficiency of the procedure. A model of FLC production, distribution, and metabolism in patients with myeloma indicated that plasma exchange might remove only 25% of the total amount during a 3-wk period. For increasing FLC removal, extended hemodialysis with a protein-leaking dialyzer was used. In vitro studies indicated that the Gambro HCO 1100 dialyzer was the most efficient of seven tested. Model calculations suggested that it might remove 90% of FLC during 3 wk. This dialyzer then was evaluated in eight patients with myeloma and renal failure. Serum FLC reduced by 35 to 70% within 2 hr, but reduction rates slowed as extravascular re-equilibration occurred. FLC concentrations rebounded on successive days unless chemotherapy was effective. Five additional patients with acute renal failure that was caused by cast nephropathy then were treated aggressively, and three became dialysis independent. A total of 1.7 kg of FLC was removed from one patient during 6 wk. Extended hemodialysis with the Gambro HCO 1100 dialyzer allowed continuous, safe removal of FLC in large amounts. Proof of clinical value now will require larger studies.

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“…Additionally, cytokine clearance rates were significantly higher in the HCO hemofiltration group. In another randomized study, HCO hemofiltration restored the monocyte proliferation capacity of septic patients, probably by eliminating immunomodulatory mediators [73]. However, the use of HCO hemofiltration has been challenged by the albumin loss, which can be up to 15 g per 4-hour session [74].…”

Section: High-adsorption Hemofiltration and High-cutoff Membranesmentioning

confidence: 99%

Clinical review: Blood purification for sepsis

2011

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Sepsis is the primary cause of death in the intensive care unit. Extracorporeal blood purification therapies have been proposed for patients with sepsis in order to improve outcomes since these therapies can alter the host inflammatory response by non-selective removal of inflammatory mediators or bacterial products or both. Recent technological progress has increased the number of techniques available for blood purification and their performance. In this overview, we report on the latest advances in blood purification for sepsis and how they relate to current concepts of disease, and we review the current evidence for high-volume hemofiltration, cascade hemofiltration, hemoadsorption, coupled plasma filtration adsorption, high-adsorption hemofiltration, and high-cutoff hemofiltration/hemodialysis. Promising results have been reported with all of these blood purification therapies, showing that they are well tolerated, effective in clearing inflammatory mediators or bacterial toxins (or both) from the plasma, and efficacious for improvement of various physiologic outcomes (for example, hemodynamics and oxygenation). However, numerous questions, including the timing, duration, and frequency of these therapies in the clinical setting, remain unanswered. Large multicenter trials evaluating the ability of these therapies to improve clinical outcomes (that is, mortality or organ failure), rather than surrogate markers such as plasma mediator clearance or transient improvement in physiologic variables, are required to define the precise role of blood purification in the management of sepsis.

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High permeability haemofiltration improves peripheral blood mononuclear cell proliferation in septic patients with acute renal failure

Abstract: HP-HF restores PBMC proliferation in septic patients probably by eliminating immunomodulatory mediators. HP-HF may represent a new renal replacement therapy able to modulate PBMC function in sepsis.

Cited by 62 publications

References 17 publications

Confirmation of High Cytokine Clearance by Hemofiltration with a Cellulose Triacetate Membrane with Large Pores: An in vivo Study

Confirmation of High Cytokine Clearance by Hemofiltration with a Cellulose Triacetate Membrane with Large Pores: An in vivo Study

Efficient Removal of Immunoglobulin Free Light Chains by Hemodialysis for Multiple Myeloma

Clinical review: Blood purification for sepsis

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