Efficacy of continuous hemodiafiltration with a cytokine-adsorbing hemofilter in the treatment of acute respiratory distress syndrome.
OBJECTIVE
In the pathophysiology of acute respiratory distress syndrome (ARDS), the increase in capillary and alveolar permeability caused by various humoral mediators and resultant pulmonary interstitial edema play major roles. In this study, the efficacy of continuous hemodiafiltration using a cytokine-adsorbing hemofilter with a membrane made of polymethylmethacrylate (PMMA-CHDF) in the treatment of ARDS patients was investigated.


METHODS
Fifty-one patients with a diagnosis of ARDS complicated by renal failure and without prior steroid therapy were enrolled in this study. Changes in respiratory index (RI), positive end-expiratory pressure, central venous pressure (CVP) and blood levels of TNFalpha, IL-6 and IL-8 before/after blood purification for 3 days as well as the cumulative water balance during the 3-day treatment and 28-day cumulative survival rate were compared between 2 patient groups. One group underwent PMMA-CHDF and the other intermittent hemodialysis (IHD) without water removal for elimination of metabolites and continuous hemofiltration (CHF) for fluid management.


RESULTS
Blood purification for 3 days significantly decreased blood levels of cytokines and successfully removed water without changing CVP in the PMMA-CHDF group, but not in the IHD+CHF group. Significant correlations between changes in blood levels of cytokines (IL-6 and IL-8) and changes in RI were demonstrated in the PMMA-CHDF group. The 28-day cumulative survival rate in the PMMA-CHDF group (68.8%) was significantly higher than that in the IHD+CHF group (36.8%).


CONCLUSIONS
Cytokine removal therapy with PMMA-CHDF is expected to be useful as a new therapeutic modality in ARDS patients for non-renal indications.
Matsuda
Kenichi
K
Moriguchi
Takeshi
T
Oda
Shigeto
S
Hirasawa
Hiroyuki
H
D016207:Cytokines / Q000097:blood / Q000302:isolation & purification*; D017583:Hemodiafiltration / Q000379:methods*; D006801:Humans; D056747:Immunomodulation; D015850:Interleukin-6; D016209:Interleukin-8; D008567:Membranes, Artificial; D019904:Polymethyl Methacrylate; D051437:Renal Insufficiency / Q000209:etiology; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000150:complications / Q000628:therapy*; D015996:Survival Rate; D014409:Tumor Necrosis Factor-alpha
D016207:Cytokines; D015850:Interleukin-6; D016209:Interleukin-8; D008567:Membranes, Artificial; D014409:Tumor Necrosis Factor-alpha; D019904:Polymethyl Methacrylate