Plasmatic cytokines and intermittent hemodialysis with polymethylmethacrylate membrane in septic shock patients
© Mayeur et al; licensee BioMed Central Ltd. 2009
Published: 13 March 2009
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) . ARF treatment requires renal replacement therapy (RRT). The cytokine plasmatic level during and after hemodialysis (HD) in septic ARF is partially described . Polymethylmethacrylate (PMMA) hemodialyser membranes own high adsorptive capacity . 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.
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.
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.
- Oberholzer A, et al.: Plasma cytokine measurements augment prognostic scores as indicators of outcome in patients with severe sepsis. Shock 2005, 23: 488-493.PubMedGoogle Scholar
- 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.PubMedView ArticleGoogle Scholar
- 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.PubMedView ArticleGoogle Scholar
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