Plasmatic cytokines and intermittent hemodialysis with polymethylmethacrylate membrane in septic shock patients

Introduction

Sepsis is mediated by many biologically active inflammatory mediators, including interleukins. IL-6, IL-8, and IL-10 *P < 0.05. are correlated with increased mortality in septic shock acute renal failure (ARF) [1]. ARF treatment requires renal replacement therapy (RRT). The cytokine plasmatic level during and after hemodialysis (HD) in septic ARF is partially described [2]. Polymethylmethacrylate (PMMA) hemodialyser membranes own high adsorptive capacity [3]. In this prospective observational trial, we study the plasmatic level of IL-6, IL-8 and IL-10 during and after the first HD seance with PMMA membrane in septic shock patients with ARF.

Methods

Inclusion criteria: patients with septic shock <24 hours as defined by the American College of Chest Physicians/Society of Critical Care Medecine and requiring RRT (Injury in the RIFLE criteria). The hemodialyser PMMA membrane was Filtrizer BK-1,6 F (TORAY Industrie, Tokyo, Japan). Data and blood samples were collected at: start of HD (D0), every hour during HD (D1; D2), at the end of HD (endD); and 30, 60, 90, 120 and 180 minutes after HD (postD0.5; postD1; postD1.5; postD2; postD3, respectively). Solid-phase ELISA was used for cytokine measurements. Statistical analysis was by Kruskall–Wallis nonparametric test.

Results

Ten patients were included. At D0: Sequential Organ Failure Assessment (14.6 ± 0.8) and IGS 2 (Simplified Acute Physiology Score II) (79.11 ± 4.73). At D0, IL-6, IL-8 and IL-10 concentration values were 767 ± 191.2, 724.4 ± 191.7 and 168.5 ± 50.44 pg/ml, respectively. Relative serum IL-8 and IL-10 concentrations versus D0 are shown in Figures 1 and 2 (mean ± SEM). The urea reduction between D0 and endD was 48.5%. The norepinephrine rate and mean arterial pressure did not change between D0 and endD (0.65 ± 0.12 vs. 0.57 ± 0.12 μg/kg/min, and 76.40 ± 4.554 vs. 83.60 ± 4.349 mmHg, respectively; P = NS).

Figure 1

Relative IL-8 concentration versus baseline. * P < 0.05.

Figure 2

Relative IL-10 concentration versus baseline.

Conclusion

PMMA membranes showed transient efficiency in IL-8 and IL-10 elimination by possible membrane saturation. The IL-6 concentration was not modified. Three hours after HD, the IL-8 and IL-10 concentrations were back to baseline. This fast increase could be explained by plasmatic rebound and must be kept in mind. This rebound could be deleterious in this stage of sepsis.