High cut-off hemofiltration versus standard hemofiltration: effect on plasma cytokines.
To study the effects of continuous veno-venous hemofiltration (CVVH) with high cut-off filters (CVVH-HCO) on plasma cytokine levels, sieving coefficient and clearance compared to CVVH using standard filters (CVVH-Std) in a nested cohort within a double-blind randomized controlled trial in severe acute kidney injury (AKI) patients.



We measured plasma and post-filter levels of IL-6, TNF-alpha, IL-8, IL-1 beta, RANTES, IL-10, IFN-gamma and IFN-alpha in both study groups. We also measured cytokine levels in the ultrafiltrate and calculated sieving coefficients and clearances.



By 72 hours of treatment, IL-6 had decreased during both treatments (p = 0.009 and 0.005 respectively). In contrast, IL-10 had decreased with CVVH-Std (p = 0.03) but not CVVH-HCO (p = 0.135). None of the other cytokines showed changes over time. There were also no significant between group differences in plasma levels for each cytokine over the 72-hour treatment period. For all cytokines combined, however, the median sieving coefficient was higher for CVVH-HCO (0.31 vs. 0.16; p = 0.042) as was the mass removal rate by ultrafiltration (p = 0.027). While overall combined cytokine levels had fallen to 62.2% of baseline at 72 hours for CVVH-HCO (p&lt;0.0001) and to 75.9% of baseline with CVVH-Std (p = 0.008) there were no between group differences.



CVVH-HCO achieved greater combined sieving coefficient and mass removal rate by ultrafiltration for a group of key cytokines than CVVH-Std. However, this effect did not differentially lower their plasma level over the first 72 hours. Our study does not support the use of CVVH-HCO to lower cytokines in critically ill patients with AKI.
Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway - Malaysia.
Rafidah
R
Atan
Department of Intensive Care, Austin Hospital, Heidelberg, Victoria - Australia.
Leah
L
Peck
St. Vincent's Hospital, University of Melbourne, Fitzroy, Melbourne - Australia.
Kumar
K
Visvanathan
St. Vincent's Hospital, University of Melbourne, Fitzroy, Melbourne - Australia.
Narelle
N
Skinner
Department of Intensive Care, Austin Hospital, Heidelberg, Victoria - Australia.
Glenn
G
Eastwood
Department of Intensive Care, Austin Hospital, Heidelberg, Victoria - Australia.|School of Medicine, University of Melbourne, Parkville, Victoria - Australia.
Rinaldo
R
Bellomo
Gambro Dialysatoren GmbH, Research & Development, Hechingen - Germany.
Markus
M
Storr
Gambro Dialysatoren GmbH, Research & Development, Hechingen - Germany.
Hermann
H
Goehl
D058186:Acute Kidney Injury / Q000097:blood* / Q000150:complications / Q000628:therapy*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016207:Cytokines / Q000097:blood*; D004311:Double-Blind Method; D005260:Female; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000150:complications / Q000628:therapy
D016207:Cytokines