Intermittent high permeability hemofiltration in septic patients with acute renal failure.
OBJECTIVE
High permeability hemofiltration (HP-HF) is a new renal replacement modality designed to facilitate the elimination of cytokines in sepsis. Clinical safety data on this new procedure is still lacking. This study investigates the effects of HP-HF on the protein and coagulation status as well as on cardiovascular hemodynamics in patients with septic shock. In addition, the clearance capacity for interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) is analyzed.


METHODS
Prospective, single-center pilot trial.


METHODS
University hospital.


METHODS
Sixteen patients with multiple organ failure (MOF) induced by septic shock were studied.


METHODS
Patients were treated by intermittent high permeability hemofiltration (iHP-HF; nominal cut-off point: 60 kilodaltons). Intermittent HP-HF was performed over 5 days for 12 h per day and alternated with conventional hemofiltration.


RESULTS
Intermittent HP-HF proved to be a safe hemofiltration modality in regard to cardiovascular hemodynamics and its impact on the coagulation status. However, transmembrane protein loss occurred and cumulative 12-h protein loss was 7.60 g (IQR: 6.2-12.0). The filtration capacity for IL-6 was exceptionally high. The IL-6 sieving coefficient approximated 1 throughout the study period. The total plasma IL-6 burden, estimated by area under curve analysis, declined over time ( p<0.001 vs baseline). The TNF-alpha elimination capacity was poor.


CONCLUSIONS
High permeability hemofiltration is a new approach in the adjuvant therapy of sepsis that facilitates the elimination of cytokines. HP-HF alternating with conventional hemofiltration is well tolerated. Further studies are needed to analyze whether HP-HF is able to mitigate the course of sepsis.
Morgera
Stanislao
S
Department of Nephrology, Charité, Humboldt University of Berlin, Schumannstrasse 20-21, 10098, Berlin, Germany, stanislao.morgera@charite.de
Rocktäschel
Jens
J
Haase
Michael
M
Lehmann
Christian
C
von Heymann
Christian
C
Ziemer
Sabine
S
Priem
Friedrich
F
Hocher
Berthold
B
Göhl
Hermann
H
Kox
Wolfgang J
WJ
Buder
Hans-W
HW
Neumayer
Hans-H
HH
D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy*; D000368:Aged; D000990:Antithrombin III / Q000378:metabolism; D019540:Area Under Curve; D001798:Blood Proteins / Q000378:metabolism; D005260:Female; D006439:Hemodynamics; D006440:Hemofiltration / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000150:complications* / Q000175:diagnosis / Q000276:immunology; D010865:Pilot Projects; D011446:Prospective Studies; D011486:Protein C / Q000378:metabolism; D011516:Prothrombin / Q000378:metabolism; D012044:Regression Analysis; D012307:Risk Factors; D012449:Safety; D012709:Serum Albumin / Q000378:metabolism; D012772:Shock, Septic / Q000150:complications* / Q000175:diagnosis / Q000276:immunology; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D001798:Blood Proteins; D015850:Interleukin-6; D011486:Protein C; D012709:Serum Albumin; D014409:Tumor Necrosis Factor-alpha; D000990:Antithrombin III; D011516:Prothrombin