title: Intermittent high permeability hemofiltration in septic patients with acute renal failure.
abstract: 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.
authors.affiliation: Department of Nephrology, Charité, Humboldt University of Berlin, Schumannstrasse 20-21, 10098, Berlin, Germany, stanislao.morgera@charite.de
authors.forename: Stanislao
authors.initials: S
authors.lastname: Morgera
authors.forename: Jens
authors.initials: J
authors.lastname: Rocktäschel
authors.forename: Michael
authors.initials: M
authors.lastname: Haase
authors.forename: Christian
authors.initials: C
authors.lastname: Lehmann
authors.forename: Christian
authors.initials: C
authors.lastname: von Heymann
authors.forename: Sabine
authors.initials: S
authors.lastname: Ziemer
authors.forename: Friedrich
authors.initials: F
authors.lastname: Priem
authors.forename: Berthold
authors.initials: B
authors.lastname: Hocher
authors.forename: Hermann
authors.initials: H
authors.lastname: Göhl
authors.forename: Wolfgang J
authors.initials: WJ
authors.lastname: Kox
authors.forename: Hans-W
authors.initials: HW
authors.lastname: Buder
authors.forename: Hans-H
authors.initials: HH
authors.lastname: Neumayer
mesh_terms: 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
chemical_list: D001798:Blood Proteins; D015850:Interleukin-6; D011486:Protein C; D012709:Serum Albumin; D014409:Tumor Necrosis Factor-alpha; D000990:Antithrombin III; D011516:Prothrombin