Tumor necrosis factor-alpha during continuous high-flux hemodialysis in sepsis with acute renal failure

Lonnemann, Gerhard; Bechstein, Mikko; Linnenweber, Silvia; Burg, M.P.M. van der; Koch, K. M.

doi:10.1046/j.1523-1755.1999.07213.x

Cited by 26 publications

(39 citation statements)

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“…10 The faster response of ET-1 to therapy, with a plasma half-life of 1.4-3.6 minutes, make it a good vasoactive peptide, mediating hemodynamics during dialysis. 31 Consistent with our report showing that free radicals and inflammatory cytokines were not increased during the SLED period, Lonneman et al 23 confirmed that daily SLED is at least as efficacious as continuous hemofiltration in modulating endotoxin-induced tumor necrosis factor-a production. Additionally, SLED offers advantages such as potential prolonged high-volume treatment to normalize indicators of uremic intoxication quickly.…”

Section: Hemodynamicssupporting

confidence: 87%

The hemodynamic effects during sustained low-efficiency dialysis versus continuous veno-venous hemofiltration for uremic patients with brain hemorrhage: a crossover study

Wu¹,

Huang²,

Shiao

et al. 2013

JNS

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Object Hemodynamic instability occurs frequently during dialysis treatment and remains a significant cause of patient morbidity and mortality, especially in patients with brain hemorrhage. This study aims to compare the effects of hemodynamic parameters and intracranial pressure (ICP) between sustained low-efficiency dialysis (SLED) and continuous veno-venous hemofiltration (CVVH) in dialysis patients with brain hemorrhage. Methods End-stage renal disease (ESRD) patients with brain hemorrhage undergoing ICP monitoring were enrolled. Patients were randomized to receive CVVH or SLED on the 1st day and were changed to the other modality on the 2nd day. The ultrafiltration rate was set at between 1.0 kg/8 hrs and 1.5 kg/8 hrs according to the patient's fluid status. The primary study end point was the change in hemodynamics and ICP during the dialytic periods. The secondary end point was the difference between cardiovascular peptides and oxidative and inflammatory assays. Results Ten patients (6 women; mean age 59.9 ± 3.6 years) were analyzed. The stroke volume variation was higher with SLED than CVVH (generalized estimating equations method, p = 0.031). The ICP level increased after both SLED and CVVH (time effect, p = 0.003) without significant difference between modalities. The dialysis dose quantification after 8-hour dialysis was higher in SLED than CVVH (equivalent urea clearance by convection, 62.7 ± 4.4 vs 50.2 ± 3.9 ml/min; p = 0.002). Additionally, the endothelin-1 level increased after CVVH treatment (p = 0.019) but not SLED therapy. Conclusions With this controlled crossover study, the authors provide the pilot evidence that both SLED and CVVH display identical acute hemodynamic effects and increased ICP after dialysis in brain hemorrhage patients. Clinical trial registration no.: NCT01781585 (ClinicalTrials.gov).

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Section: Hemodynamicssupporting

confidence: 87%

The hemodynamic effects during sustained low-efficiency dialysis versus continuous veno-venous hemofiltration for uremic patients with brain hemorrhage: a crossover study

Wu¹,

Huang²,

Shiao

et al. 2013

JNS

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“…It has mainly been developed to optimize the clearance of middle molecules without compromising the clearance of urea. Early studies have shown cytokine removal with CHFD, so the potential to exploit this therapy for sepsis certainly exists (113). Unfortunately, there are very limited data on the use of CHFD as a mode of EBP in human sepsis.…”

Section: Different Purification Technologies and Their Evaluation In mentioning

confidence: 99%

Potential Interventions in Sepsis-Related Acute Kidney Injury

Ronco¹,

Kellum²,

Bellomo³

et al. 2008

Clinical Journal of the American Society of Nephrology

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Sepsis is an important cause of morbidity and mortality. Acute kidney injury often complicates sepsis, leading to greater complexity, cost of care, and worsening prognosis. In recent years, a consensus definition of acute kidney injury has been developed, facilitating research into the pathophysiology and epidemiology of this disorder. New and emerging biomarkers to recognize kidney injury before functional abnormalities are manifest may allow early recognition and facilitate prevention or treatment. Furthermore, advances in the clinical management of sepsis may have secondary benefits with respect to renal outcomes. Existing and hybrid extracorporeal therapies are being investigated not only as means to replace lost kidney function but also to modulate the immune response to sepsis. For those who have more advanced forms of kidney injury, strategies to promote renal recovery are being sought to minimize the long-term consequences of impaired kidney function. This review provides an update on the current state of the science and a glimpse toward the future of intervention in sepsis-related acute kidney injury.

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“…Although previous research has indicated that TNF-α could not be filtrated due to trimer formation in plasma, [28] recent study had shown that it can be removed in high volume CRRT. [29] We believe that TNF-α can also be removed by convection in HDF.…”

Section: Discussionmentioning

confidence: 93%