Sorbents in acute renal failure and the systemic inflammatory response syndrome.
Renal replacement therapy in acute renal failure is currently focused on the use of modifications of dialysis (continuous arteriovenous hemofiltration and hemodiafiltration) to remove middle molecular weight toxins, consisting of small proteins, and cytokines involved in the systemic inflammatory response syndrome (SIRS). Conventional high-flux dialyzers are not efficient at removing these molecules, prompting the investigation of sorbents to augment or replace dialysis. Sorbents have been developed to modulate SIRS by targeting cytokines such as IL-1, IL-6, IL-10, IL-18 and TNF, among others. Extensive pre-clinical studies are underway to demonstrate the clinical utility and safety of either adding sorbent hemoadsorption devices to hemodialysis, or the use of such devices alone in SIRS, sepsis, acute renal failure, cardiopulmonary bypass and end-stage renal disease.
Winchester
James F
JF
RenalTech International, New York, NY 10021, USA. jamesw@renaltech.com
Kellum
John A
JA
Ronco
Claudio
C
Brady
James A
JA
Quartararo
Peter J
PJ
Salsberg
Jamie A
JA
Levin
Nathan W
NW
D058186:Acute Kidney Injury / Q000209:etiology / Q000628:therapy*; D000327:Adsorption; D016207:Cytokines / Q000097:blood / Q000302:isolation & purification; D006801:Humans; D006435:Renal Dialysis / Q000295:instrumentation* / Q000379:methods; D012117:Resins, Synthetic; D018805:Sepsis / Q000150:complications / Q000276:immunology; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications / Q000276:immunology / Q000628:therapy*
D016207:Cytokines; D012117:Resins, Synthetic