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Table 2 The main studies describing the effectiveness/limitations of high cut-off membranes

From: Extracorporeal techniques for the treatment of critically ill patients with sepsis beyond conventional blood purification therapy: the promises and the pitfalls

 

Morgera et al. 2003 [28, 29]

Morgera et al. 2004 [27]

Morgera et al. 2006 [30]

Haase et al. 2007 [31]

Chelazzi et al. 2016 [32]

Kade et al. 2016 [34]

Villa et al. 2017 [33]

Study design

Prospective single-center pilot trial

Prospective RCT

Prospective RCT

Double-blind, crossover RCT

Retrospective, observational

Retrospective, single center

Observational prospective multicenter study

Study population (n)

16 septic shock patients

24 patients with sepsis-induced AKI

30 septic patients with AKI

10 septic patients with AKI

16 patients with Gram-negative sepsis

28 patients with septic shock

38 patients with septic shock and AKI

Prescribed dose

Intermittent HP-HF over 5 days for 12 h/day alternating with conventional HF (12 h)

CVVH (UF 1 L/h) vs CVVH (UF 2.5 L/h) vs CVVHD (dialysate flow rate of 1 L/h) vs CVVHD (dialysate flow rate of 2.5 L/h)

HCO vs conventional HF

4 h of HCO-IHD and 4 h of HF-IHD

HCO 35 ml/kg/h vs CVVHDF 45 ml/kg/h

HCO-CVVHDF

HCO-CVVHD for 72 h

Results

High IL-6 elimination

Increasing UF volume or dialysate flow led to a significant increase in IL-1ra and IL-6 clearance rates (p < 0.00001)

Significant reduction in VP dose in the HCO group (p = 0.0002)

Clearance rates for IL-6 and IL-1ra were significantly higher in the HCO group (p < 0.0001)

Greater decrease in plasma IL-6 levels (p = 0.05), plasma IL-8 (p = 0.02) and plasma IL-10 (p = 0.04) in the HCO group

ICU mortality rates were 37.5 and 87.5% for HCO and HF groups, respectively (p = 0.03)

ICU LOS: 16 and 9 days (HCO- and HF-group; p = 0.03).

Improvement of hemodynamics in the HCO group (p < 0.03)

Significant reduction in IL-10 and IL-12 levels

Significant reduction in circulating levels of TNFα and IL-6 among survivors

Safety or S/E

High cumulative 12-h protein loss (7.60 g; IQR 6.2–12.0)

High protein and albumin losses with 2.5-L/h HF mode

None

Albumin loss of 7.7 g in the HCO group vs < 1.0 g (p < 0.01)

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  1. RCT randomized controlled trial, AKI acute kidney injury, HCO high cut-off, CVVH continuous veno-venous hemofiltration, CVVHD continuous veno-venous hemodialysis, CVVHDF continuous veno-venous hemodiafiltration, HP-HF high permeability hemofiltration. UF ultrafiltration, HCO-IHD high cut-off intermittent hemodialysis, HF-IHD high flux intermittent hemodialysis, HF hemofiltration, TNF tumor necrosis factor, IL interleukin, LOS length of stay, VP vasopressors, IQR interquartile range
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Critical Care

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