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Intermittent high permeability hemofiltration in septic patients with acute renal failure

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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-α (TNF-α) 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-α 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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Authors and Affiliations

  1. Department of Nephrology, Charité , Humboldt University of Berlin, Schumannstrasse 20–21, 10098, Berlin, Germany

    Stanislao Morgera, Jens Rocktäschel, Michael Haase, Berthold Hocher, Hans-W. Buder & Hans-H. Neumayer

  2. Department of Anesthesiology, Charité, Humboldt University of Berlin, Schumannstrasse 20–21, 10098 , Berlin, Germany

    Christian Lehmann, Christian von Heymann & Wolfgang J. Kox

  3. Laboratory Medicine and Pathobiochemistry, Charité , Humboldt University of Berlin, Schumannstrasse 20–21, 10098, Germany

    Sabine Ziemer & Friedrich Priem

  4. Clinical Research, Medical and Biological Research Gambro Dialysatoren GmbH& Co. KG, Holger-Crafoord-Strasse 26, 72373, Hechingen, Germany

    Hermann Göhl

Authors
  1. Stanislao Morgera
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  2. Jens Rocktäschel
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  3. Michael Haase
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  4. Christian Lehmann
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  5. Christian von Heymann
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  6. Sabine Ziemer
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  7. Friedrich Priem
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  8. Berthold Hocher
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  9. Hermann Göhl
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  10. Wolfgang J. Kox
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  11. Hans-W. Buder
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  12. Hans-H. Neumayer
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Correspondence to Stanislao Morgera.

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Morgera, S., Rocktäschel, J., Haase, M. et al. Intermittent high permeability hemofiltration in septic patients with acute renal failure. Intensive Care Med 29, 1989–1995 (2003). https://doi.org/10.1007/s00134-003-2003-9

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  • DOI: https://doi.org/10.1007/s00134-003-2003-9

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