Pilot study on the effects of high cutoff hemofiltration on the need for norepinephrine in septic patients with acute renal failure.
OBJECTIVE
High cutoff hemofilters are characterized by an increased effective pore size designed to facilitate the elimination of inflammatory mediators in sepsis. Clinical data on this new renal replacement modality are lacking.


METHODS
Prospective, randomized clinical trial.


METHODS
University hospital, intensive care units.


METHODS
: Thirty patients with sepsis-induced acute renal failure.


METHODS
Patients were allocated to high cutoff (n = 20) or conventional (n = 10) hemofiltration in a 2:1 ratio. Median renal replacement dose was 31 mL/kg/hr. For high cutoff hemofiltration, a high-flux hemofilter with an in vivo cutoff point of approximately 60 kilodaltons was used. Conventional hemofiltration was performed with a standard high-flux hemofilter (PF11S). The impacts of high cutoff hemofiltration on the need for norepinephrine and on plasma levels and clearance rates for interleukin (IL)-6 and IL-1 receptor antagonist (IL-1ra) were analyzed. Absolute values, but also adjusted values (expressed as proportion of baseline), were analyzed. The observation period was restricted to 48 hrs.


RESULTS
Apart from higher antithrombin III levels at entry into the study, main clinical and laboratory parameters were comparable between both groups. The median norepinephrine dose at entry into the study was 0.30 microg/kg/min in the high cutoff group and 0.21 microg/kg/min in the conventional hemofiltration group (p = .448). Only the high cutoff group showed a significant decline (p = .0002) in "adjusted" norepinephrine dose over time. Clearance rates for IL-6 and IL-1ra were significantly higher in the high cutoff hemofiltration group (p < .0001), which translated into a significant decline of the corresponding plasma levels (p = .0465 for IL-6; p = .0293 for IL-1ra).


CONCLUSIONS
In this pilot study, high cutoff hemofiltration has been shown to exert a beneficial effect on the need for norepinephrine in septic patients with acute renal failure. In addition, we demonstrate that high cutoff hemofiltration is superior to conventional hemofiltration in the elimination of IL-6 and IL-1ra from the circulating blood of septic patients.
Morgera
Stanislao
S
Department of Nephrology, Charité, Humboldt University of Berlin, Germany.
Haase
Michael
M
Kuss
Thomas
T
Vargas-Hein
Ortrud
O
Zuckermann-Becker
Heidrun
H
Melzer
Christoph
C
Krieg
Hanno
H
Wegner
Brigitte
B
Bellomo
Rinaldo
R
Neumayer
Hans-H
HH
D058186:Acute Kidney Injury / Q000097:blood / Q000276:immunology / Q000628:therapy*; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D004280:Dobutamine / Q000627:therapeutic use; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use*; D010865:Pilot Projects; D011446:Prospective Studies; D017472:Receptors, Interleukin-1 / Q000037:antagonists & inhibitors; D018805:Sepsis / Q000097:blood* / Q000276:immunology; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D000318:Adrenergic beta-Agonists; D015850:Interleukin-6; D017472:Receptors, Interleukin-1; D014662:Vasoconstrictor Agents; D004280:Dobutamine; D002097:C-Reactive Protein; D009638:Norepinephrine; D004837:Epinephrine