Intermittent high permeability hemofiltration in septic patients with acute renal failure

• Published in: Intensive care medicine 2003-11, Vol.29 (11), p.1989-1995
• Main Authors: MORGERA, Stanislao, ROCKTÄSCHEL, Jens, BUDER, Hans-W, NEUMAYER, Hans-H, HAASE, Michael, LEHMANN, Christian, VON HEYMANN, Christian, ZIEMER, Sabine, PRIEM, Friedrich, HOCHER, Berthold, GÖHL, Hermann, KOX, Wolfgang J
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - blood; Acute Kidney Injury - diagnosis; Acute Kidney Injury - microbiology; Acute Kidney Injury - therapy; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antithrombin III - metabolism; Area Under Curve; Biological and medical sciences; Blood Proteins - metabolism; Cytokines; Emergency and intensive care: renal failure. Dialysis management; Female; Hemodynamics; Hemofiltration - adverse effects; Hemofiltration - methods; Humans; Intensive care; Intensive care medicine; Interleukin-6 - blood; Male; Medical sciences; Middle Aged; Multiple organ dysfunction syndrome; Multiple Organ Failure - complications; Multiple Organ Failure - diagnosis; Multiple Organ Failure - immunology; Permeability; Pilot Projects; Prospective Studies; Protein C - metabolism; Proteins; Prothrombin - metabolism; Regression Analysis; Risk Factors; Safety; Sepsis; Serum Albumin - metabolism; Shock, Septic - complications; Shock, Septic - diagnosis; Shock, Septic - immunology; Time Factors; Treatment Outcome; Tumor Necrosis Factor-alpha - metabolism; Tumor necrosis factor-TNF
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-003-2003-9

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. Prospective, single-center pilot trial. University hospital. Sixteen patients with multiple organ failure (MOF) induced by septic shock were studied. 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. 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