title: Continuous hemodiafiltration with a cytokine-adsorbing hemofilter for sepsis.
abstract: Since the introduction of the new pathophysiological concept of pathogen-associated molecular patterns (PAMPS) and alarmins, endotoxin has been recognized as only one of the PAMPS. It is widely accepted that hypercytokinemia plays a pivotal role in the pathophysiology of sepsis. Many kinds of blood purification modalities have been proposed as a therapeutic tool against sepsis, including high-volume continuous hemofiltration whose efficacy has recently been questioned. We report that continuous hemodiafiltration (CHDF) with a cytokine-adsorbing hemofilter (CAH), such as polymethyl methacrylate hemofilter and AN69ST hemofilter (CAH-CHDF), can remove many kinds of cytokines and has been very effective in the treatment of severe sepsis and septic shock. Based on the understanding of the recent pathophysiology, we suggest that CAH-CHDF is an alternate therapy to direct hemoperfusion with endotoxin-adsorbing column in the treatment of sepsis.
authors.affiliation: Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. hhirasawa@faculty.chiba-u.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hirasawa
authors.forename: Shigeto
authors.initials: S
authors.lastname: Oda
authors.forename: Masataka
authors.initials: M
authors.lastname: Nakamura
authors.forename: Eizo
authors.initials: E
authors.lastname: Watanabe
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Shiga
authors.forename: Kenichi
authors.initials: K
authors.lastname: Matsuda
mesh_terms: D000327:Adsorption; D016207:Cytokines / Q000097:blood* / Q000276:immunology / Q000302:isolation & purification*; D017583:Hemodiafiltration / Q000295:instrumentation*; D006801:Humans; D019904:Polymethyl Methacrylate / Q000737:chemistry; D011112:Polymyxin B / Q000737:chemistry; D018805:Sepsis / Q000097:blood* / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*
chemical_list: D016207:Cytokines; D019904:Polymethyl Methacrylate; D011112:Polymyxin B