Intermittent high-permeability hemofiltration modulates inflammatory response in septic patients with multiorgan failure.
OBJECTIVE
Continuous venovenous hemofiltration with high-permeability hemofilters is a novel approach in the adjuvant therapy of septic patients. High-permeability hemofilters are characterized by an increased pore size which facilitates the filtration of inflammatory mediators. The present study examines whether intermittent high-permeability hemofiltration has an immunomodulatory effect on polymorphonuclear leukocytes and mononuclear cells.


METHODS
Twenty-eight septic patients with acute renal failure were randomly allocated to either receive intermittent high-permeability or conventional hemofiltration. Intermittent high-permeability hemofiltration consisted of a daily 12-hour course of high-permeability hemofiltration alternated by conventional hemofiltration. For high-permeability hemofiltration, a newly developed high-flux polyamide membrane (P2SH) with a nominal cutoff point of 60 kD was used. For conventional hemofiltration a high-flux polyamide hemofilter (Polyflux 11S, cutoff point 30 kD) was used.


RESULTS
The polymorphonuclear leukocyte phagocytosis activity before starting hemofiltration was almost double the rate of healthy controls in both groups (p < 0.001). The phagocytosis rate decreased significantly during the course of intermittent high-permeability hemofiltration (p < 0.05), whereas the values remained unchanged in the conventional hemofiltration group. Incubation of high-permeability filtrates with blood from healthy donors resulted in a significant induction of phagocytosis (p < 0.001), whereas conventional filtrates had no phagocytosis-stimulating effects. In addition, incubation of healthy-donor mononuclear cells with high-permeability but not conventional filtrates resulted in a significant tumor necrosis factor alpha release (p < 0.001).


CONCLUSIONS
Intermittent high-permeability hemofiltration is a novel extracorporeal elimination modality which exhibits immunomodulatory effects on leukocytes, attenuating polymorphonuclear neutrophil phagocytosis. Further studies are necessary to elucidate whether these effects translate in a clinical improvement in patients suffering from sepsis.
Morgera
Stanislao
S
Department of Nephrology, Charité, Humboldt University of Berlin, Berlin, Germany. stanislao.morgera@charite.de
Haase
Michael
M
Rocktäschel
Jens
J
Böhler
Torsten
T
Vargas-Hein
Ortrud
O
Melzer
Christoph
C
Krausch
Dietmar
D
Kox
Wolfgang J
WJ
Baumann
Gerd
G
Beck
Werner
W
Göhl
Hermann
H
Neumayer
Hans-H
HH
D058186:Acute Kidney Injury / Q000097:blood / Q000503:physiopathology / Q000628:therapy; D002199:Capillary Permeability; D005260:Female; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D007963:Leukocytes, Mononuclear / Q000378:metabolism / Q000502:physiology; D008297:Male; D009102:Multiple Organ Failure / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D009504:Neutrophils / Q000378:metabolism / Q000502:physiology; D010587:Phagocytosis / Q000502:physiology; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D018836:Inflammation Mediators; D014409:Tumor Necrosis Factor-alpha