Super high flux hemofiltration: a new technique for cytokine removal.
OBJECTIVE
To test whether hemofiltration using a hemofilter with large pores (super high flux hemofiltration) achieves effective cytokine removal.


METHODS
: Ex vivo study.


METHODS
Laboratory of an intensive care unit in a tertiary hospital.


METHODS
Five healthy volunteers.


METHODS
Blood was spiked with 1 mg of endotoxin and then circulated through a closed hemofiltration circuit with a large pore polyamide super high flux hemofilter (nominal cut-off point: 100 kDa). Hemofiltration was conducted at 1 l/h or 6 l/h of ultrafiltrate flow. Samples were taken from the arterial, venous and ultrafiltration sampling ports.


RESULTS
Sieving coefficients (SC) above 0.6 were achieved for interleukin (IL)-1beta, IL-6 and IL-10 and SCs above 0.3 were achieved for IL-8 and TNF-alpha at 1 l/h. SCs of all cytokines (except IL-1) were reduced when the ultrafiltration rate was increased from 1 l/h to 6 l/h ( p<0.01), but cytokine clearances still increased ( p<0.01). The highest SC for albumin was 0.1 at 1 l/h and fell to 0.01 at 6 l/h. No adsorption of cytokines and albumin was observed.


CONCLUSIONS
High volume ultrafiltration using a super high flux filter achieved cytokine clearances comparable to, or greater than, those currently achieved for urea during standard continuous renal replacement therapy.
Uchino
S
S
Department of Intensive Care and Department of Medicine, Austin & Repatriation Medical Centre, Heidelberg, Melbourne, Victoria 3084, Australia.
Bellomo
R
R
Goldsmith
D
D
Davenport
P
P
Cole
L
L
Baldwin
I
I
Panagiotopoulos
S
S
Tipping
P
P
D000418:Albumins / Q000493:pharmacokinetics; D016207:Cytokines / Q000493:pharmacokinetics*; D006440:Hemofiltration / Q000295:instrumentation*; D006801:Humans; D008567:Membranes, Artificial; D008851:Micropore Filters
D000418:Albumins; D016207:Cytokines; D008567:Membranes, Artificial