High permeability haemofiltration improves peripheral blood mononuclear cell proliferation in septic patients with acute renal failure.
BACKGROUND
Continuous veno-venous haemofiltration (HF) with high permeability (HP) haemofilters is a novel approach in the adjuvant therapy of septic patients. HP haemofilters are characterized by an increased pore size which facilitates the filtration of inflammatory mediators. The present study examines whether HP-HF has an impact on peripheral blood mononuclear cell (PBMC) proliferation and whether ultrafiltrate can alter PBMC function in isolates from healthy volunteers.


METHODS
Twenty-eight septic patients with acute renal failure were randomly allocated to either HP-HF or conventional HF (C-HF). HP-HF was performed with a newly developed high-flux polyamide membrane (P2SH) with a nominal cut-off point of 60 kDa. For C-HF, a high-flux polyamide haemofilter (Polyflux 11S; cut-off, 30 kDa) was used.


RESULTS
Septic patients demonstrated a significantly reduced proliferation of anti-CD3-stimulated PBMCs compared to healthy controls (P = 0.016). Initiating HF led to a restoration of the PBMC proliferation in HP-HF but not in C-HF. Exposing PBMCs isolated from healthy donors to ultrafiltrates from patients with sepsis demonstrated a significant suppressive effect of HP ultrafiltrates on the anti-CD3-stimulated PBMC proliferation (P = 0.011). Ultrafiltrate from patients with sepsis who received C-HF had no impact on PBMC proliferation.


CONCLUSIONS
HP-HF restores PBMC proliferation in septic patients probably by eliminating immunomodulatory mediators. HP-HF may represent a new renal replacement therapy able to modulate PBMC function in sepsis.
Morgera
Stanislao
S
Department of Nephrology, Charité, Humboldt University of Berlin, Schumannstrasse 20-21, D-10098 Berlin, Germany. stanislao.morgera@charite.de
Haase
Michael
M
Rocktäschel
Jens
J
Böhler
Torsten
T
von Heymann
Christian
C
Vargas-Hein
Ortrud
O
Krausch
Dietmar
D
Zuckermann-Becker
Heidrun
H
Müller
Joachim M
JM
Kox
Wolfgang J
WJ
Neumayer
Hans H
HH
D058186:Acute Kidney Injury / Q000209:etiology / Q000276:immunology* / Q000628:therapy*; D000368:Aged; D002455:Cell Division; D016207:Cytokines / Q000276:immunology; D005260:Female; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D007963:Leukocytes, Mononuclear / Q000166:cytology / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D010539:Permeability; D018805:Sepsis / Q000150:complications / Q000276:immunology* / Q000628:therapy*
D016207:Cytokines