title: High permeability haemofiltration improves peripheral blood mononuclear cell proliferation in septic patients with acute renal failure.
abstract: 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.
authors: Department of Nephrology, Charité, Humboldt University of Berlin, Schumannstrasse 20-21, D-10098 Berlin, Germany. stanislao.morgera@charite.de
authors: Stanislao
authors: S
authors: Morgera
authors: Michael
authors: M
authors: Haase
authors: Jens
authors: J
authors: Rocktäschel
authors: Torsten
authors: T
authors: Böhler
authors: Christian
authors: C
authors: von Heymann
authors: Ortrud
authors: O
authors: Vargas-Hein
authors: Dietmar
authors: D
authors: Krausch
authors: Heidrun
authors: H
authors: Zuckermann-Becker
authors: Joachim M
authors: JM
authors: Müller
authors: Wolfgang J
authors: WJ
authors: Kox
authors: Hans H
authors: HH
authors: Neumayer
mesh_terms: 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*
chemical_list: D016207:Cytokines