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  • Title: Intermittent high permeability hemofiltration in septic patients with acute renal failure.
    Author: Morgera S, Rocktäschel J, Haase M, Lehmann C, von Heymann C, Ziemer S, Priem F, Hocher B, Göhl H, Kox WJ, Buder HW, Neumayer HH.
    Journal: Intensive Care Med; 2003 Nov; 29(11):1989-95. PubMed ID: 12955174.
    Abstract:
    OBJECTIVE: High permeability hemofiltration (HP-HF) is a new renal replacement modality designed to facilitate the elimination of cytokines in sepsis. Clinical safety data on this new procedure is still lacking. This study investigates the effects of HP-HF on the protein and coagulation status as well as on cardiovascular hemodynamics in patients with septic shock. In addition, the clearance capacity for interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) is analyzed. DESIGN: Prospective, single-center pilot trial. SETTING: University hospital. PATIENTS: Sixteen patients with multiple organ failure (MOF) induced by septic shock were studied. INTERVENTION: Patients were treated by intermittent high permeability hemofiltration (iHP-HF; nominal cut-off point: 60 kilodaltons). Intermittent HP-HF was performed over 5 days for 12 h per day and alternated with conventional hemofiltration. MEASUREMENTS AND RESULTS: Intermittent HP-HF proved to be a safe hemofiltration modality in regard to cardiovascular hemodynamics and its impact on the coagulation status. However, transmembrane protein loss occurred and cumulative 12-h protein loss was 7.60 g (IQR: 6.2-12.0). The filtration capacity for IL-6 was exceptionally high. The IL-6 sieving coefficient approximated 1 throughout the study period. The total plasma IL-6 burden, estimated by area under curve analysis, declined over time ( p<0.001 vs baseline). The TNF-alpha elimination capacity was poor. CONCLUSIONS: High permeability hemofiltration is a new approach in the adjuvant therapy of sepsis that facilitates the elimination of cytokines. HP-HF alternating with conventional hemofiltration is well tolerated. Further studies are needed to analyze whether HP-HF is able to mitigate the course of sepsis.
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