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Continuous renal replacement therapy with a polymethyl methacrylate membrane hemofilter suppresses inflammation in patients after open-heart surgery with cardiopulmonary bypass

  • Original Article
  • Cardiopulmonary Bypass
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Abstract

Cardiopulmonary bypass (CPB) induces a complex inflammatory response involving an increase in inflammatory cytokines, called postperfusion syndrome. Previous studies demonstrated that adsorption of the serum cytokines can reduce acute inflammation and improve clinical outcomes. In this study, patients were placed on continuous renal replacement therapy (CRRT) with a polymethyl methacrylate (PMMA) membrane hemofilter immediately after the start of an open-heart surgery with CPB and throughout the postoperative course to prevent postperfusion syndrome. The aim of this study was to assess whether continuous CRRT using a PMMA filter (PMMA–CRRT) could affect cytokine expression and improve perioperative outcomes. We designed a randomized controlled trial, which included 19 consecutive adult patients on maintenance dialysis and 7 consecutive adult patients who were not on maintenance dialysis (NHD group). Patients on maintenance dialysis were randomly divided into two groups: Ten patients who received CRRT with a polysulfone membrane hemofilter (PS group) and nine patients who received CRRT with a PMMA membrane (PMMA group). Blood samples were collected from the radial or brachial artery at five different time points. Comparisons between the PS, PMMA, and NHD groups revealed a significant main effect of time on changes in serum IL-6 and IL-8 concentrations (p < 0.01) and an interaction (p < 0.05) between time and group. Plasma IL-6 and IL-8 levels after surgery were significantly lower in the PMMA group than in the PS group, while other cytokines measured in this study were not significantly different. In addition, clinical outcomes were not significantly different between the groups. The continuous use of PMMA-CRRT throughout the perioperative period suppressed serum IL-6 and IL-8 concentrations, although there were no differences in clinical outcomes.

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Acknowledgements

We thank all the staff for their assistance in conducting this study. This research received no specific Grants from any funding agency in the public, commercial, or not-for-profit sectors.

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This research received no specific Grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan

    Hiroshi Mukaida, Satoshi Matsushita & Atsushi Amano

  2. Department of Clinical Engineering, Juntendo University Hospital, Tokyo, Japan

    Hiroshi Mukaida & Takahiro Inotani

  3. Department of Clinical Engineering, Faculty of Health Sciences, Kyorin University, Tokyo, Japan

    Atsushi Nakamura

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  1. Hiroshi Mukaida
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  2. Satoshi Matsushita
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  3. Takahiro Inotani
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Correspondence to Satoshi Matsushita.

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Mukaida, H., Matsushita, S., Inotani, T. et al. Continuous renal replacement therapy with a polymethyl methacrylate membrane hemofilter suppresses inflammation in patients after open-heart surgery with cardiopulmonary bypass. J Artif Organs 21, 188–195 (2018). https://doi.org/10.1007/s10047-018-1025-6

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  • DOI: https://doi.org/10.1007/s10047-018-1025-6

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