title: Pilot study on the effects of high cutoff hemofiltration on the need for norepinephrine in septic patients with acute renal failure.
abstract: 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.
authors.affiliation: Department of Nephrology, Charité, Humboldt University of Berlin, Germany.
authors.forename: Stanislao
authors.initials: S
authors.lastname: Morgera
authors.forename: Michael
authors.initials: M
authors.lastname: Haase
authors.forename: Thomas
authors.initials: T
authors.lastname: Kuss
authors.forename: Ortrud
authors.initials: O
authors.lastname: Vargas-Hein
authors.forename: Heidrun
authors.initials: H
authors.lastname: Zuckermann-Becker
authors.forename: Christoph
authors.initials: C
authors.lastname: Melzer
authors.forename: Hanno
authors.initials: H
authors.lastname: Krieg
authors.forename: Brigitte
authors.initials: B
authors.lastname: Wegner
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.forename: Hans-H
authors.initials: HH
authors.lastname: Neumayer
mesh_terms: 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*
chemical_list: D000318:Adrenergic beta-Agonists; D015850:Interleukin-6; D017472:Receptors, Interleukin-1; D014662:Vasoconstrictor Agents; D004280:Dobutamine; D002097:C-Reactive Protein; D009638:Norepinephrine; D004837:Epinephrine