High Cut-Off Hemofiltration versus Standard Hemofiltration: Effect on Plasma Cytokines

• Published in: International journal of artificial organs 2016-09, Vol.39 (9), p.479-486
• Main Authors: Atari, Rafidah, Peck, Leah, Visvanathan, Kumar, Skinner, Narelle, Eastwood, Glenn, Bellomo, Rinaldo, Storr, Markus, Goehl, Hermann
• Format: Article
• Language: English
• Subjects: Clearances; Coefficients; Cut-off; Cytokines; Mathematical analysis; Patients; Ultrafiltration
• ISSN: 0391-3988; 1724-6040
• DOI: 10.5301/ijao.5000527

Purpose 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. Methods 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. Results 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