title: Interpreting the mechanisms of continuous renal replacement therapy in sepsis: the peak concentration hypothesis.
abstract: Severe sepsis and septic shock are the primary causes of multiple organ dysfunction syndrome (MODS), which is the most frequent cause of death in intensive care unit patients. Many water-soluble mediators with pro- and anti-inflammatory action such as TNF, IL-6, IL-8, and IL-10 play a strategic role in septic syndrome. In intensive care medicine, blocking any one mediator has not led to a measurable outcome improvement in patients with sepsis. CRRT is a continuously acting therapy, which removes in a nonselective way pro- and anti-inflammatory mediators; "the peak concentration hypothesis" is the concept of cutting peaks of soluble mediators through continuous hemofiltration. Furthermore, there is evidence of increased efficacy of high-volume hemofiltration compared to conventional CVVH, and other blood purification techniques that utilize large-pore membranes or sorbent plasmafiltration are conceptually interesting.
authors.affiliation: Department of Nephrology, St. Bortolo Hospital, Vicenza, Italy. cronco@goldnet.it
authors.forename: Claudio
authors.initials: C
authors.lastname: Ronco
authors.forename: Ciro
authors.initials: C
authors.lastname: Tetta
authors.forename: Filippo
authors.initials: F
authors.lastname: Mariano
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Wratten
authors.forename: Monica
authors.initials: M
authors.lastname: Bonello
authors.forename: Valeria
authors.initials: V
authors.lastname: Bordoni
authors.forename: Ximena
authors.initials: X
authors.lastname: Cardona
authors.forename: Paola
authors.initials: P
authors.lastname: Inguaggiato
authors.forename: Lidia
authors.initials: L
authors.lastname: Pilotto
authors.forename: Vince
authors.initials: V
authors.lastname: d'Intini
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000517:prevention & control; D016638:Critical Illness; D016207:Cytokines / Q000378:metabolism / Q000502:physiology*; D006801:Humans; D009102:Multiple Organ Failure / Q000209:etiology / Q000517:prevention & control; D017582:Renal Replacement Therapy / Q000379:methods*; D018805:Sepsis / Q000628:therapy*
chemical_list: D016207:Cytokines