Biocompatible membranes in acute renal failure: prospective case-controlled study

• Published in: The Lancet (British edition) 1994-08, Vol.344 (8922), p.570-572
• Main Authors: Schiffl, H, Lang, S.M, König, A, Strasser, T, Haider, M, Held, E
• Format: Article
• Language: English
• Subjects: Acrylic Resins; Acrylonitrile - analogs & derivatives; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biocompatibility; Biocompatible Materials; Biological and medical sciences; Case-Control Studies; Cellulose - analogs & derivatives; Complement activation; Complement C3a - analysis; Dialysis; Disease control; Emergency and intensive care: renal failure. Dialysis management; Female; Hemodialysis; Humans; Incompatibility; Inflammation; Intensive care medicine; Kidney Tubular Necrosis, Acute - blood; Kidney Tubular Necrosis, Acute - immunology; Kidney Tubular Necrosis, Acute - therapy; Kidneys; Leukotriene B4; Leukotriene B4 - blood; Male; Medical research; Medical sciences; Membranes; Membranes, Artificial; Middle Aged; Mortality; Patients; Polyacrylonitrile; Prospective Studies; Reaction kinetics; Renal Dialysis - instrumentation; Renal failure; Sepsis; Severity of Illness Index; Side effects; Statistical analysis; Survival
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(94)91964-X

Summary The mortality of critically ill patients with acute renal failure has been halved through intervention by haemodialysis. However, several reports suggest that the course of the disorder may be prolonged by this procedure. Our prospective randomised study was done to see whether the generation of inflammatory mediators by bio-incompatible membranes has an adverse effect on the outcome of acute renal failure. 52 patients, similar in age, severity of acute renal failure, general disease status (APACHE II), and management of acute renal failure or its related conditions, were divided into two groups. Haemodialysis was done with cuprophane or polyacrylonitrile membranes. Cuprophane membranes induced intense activation of the complement system (as judged by measurement of C3a) and lipooxygenase pathway (leukotriene B4) resulting in alterations of neutrophil kinetics and function. The cuprophane group had a lower survival rate (38 vs 65%), a higher proportion of patients dying from sepsis (71 vs 40%), required more haemodialysis sessions (12 vs 9), and demonstrated delayed resolution and recovery from acute renal failure than the polyacrylonitrile group. The difference in mortality regarding lethal sepsis as cause of death was statistically significant. Our observations indicate that the outcome of critically ill patients with acute renal failure may be influenced by bio-incompatibility reactions to the dialysis membrane. These results have direct implications for such patients on haemodialysis.