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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
figure1

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

Figure 2
figure2

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.

References

  1. 1.

    Oberholzer A, et al.: Plasma cytokine measurements augment prognostic scores as indicators of outcome in patients with severe sepsis. Shock 2005, 23: 488-493.

  2. 2.

    Haase M, et al.: Hemodialysis membrane with a highmolecular-weight cutoff and cytokine levels in sepsis complicated by acute renal failure: a phase 1 randomized trial. Am J Kidney Dis 2007, 50: 296-304.

  3. 3.

    Hirasawa H, et al.: Continuous hemofiltration with cytokine-adsorbing hemofilter in the treatment of severe sepsis and septic shock. Contrib Nephrol 2007, 156: 365-370.

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Mayeur, N., Lavayssiere, L., Nogier, M. et al. Plasmatic cytokines and intermittent hemodialysis with polymethylmethacrylate membrane in septic shock patients. Crit Care 13, P278 (2009). https://doi.org/10.1186/cc7442

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Keywords

  • PMMA
  • Polymethylmethacrylate
  • Acute Renal Failure
  • Renal Replacement Therapy
  • Sequential Organ Failure Assessment