[en] Objective: To confirm in vivo the hypothesis that hemofiltration with a large pore membrane can achieve significant cytokine clearance. Method: We used a well-known animal model of endotoxinic shock (0.5 mg/kg of lipopolysaccharide from Escherichia Coli over a period of 30 mins). Six pigs were hemofiltrated for 3 hours with a large pore membrane (78 angstrom pore, 80 kDa cut off) (Sureflux FH 70, Nipro, Osaka, Japan). The ultrafiltration rate was 45 ml/kg/min. Samples were taken from arterial, venous line and in the ultrafiltrate at T120 and T240. We measured concentrations of interleukin 6, interleukin 10 and albumin. Results: At T120 and T240, the IL-6 clearances were 22 +/- 7 and 15 +/- 3 ml/min, respectively. The IL-6 sieving coefficients were 0.97 and 0.7 at T120 and T240, respectively. At T120 and T240, the IL-10 clearances were 14 +/- 4 and 10 +/- 7 ml/min, respectively. The sieving coefficients were 0.63 and 0.45 at T120 and T240, respectively. The concentrations of IL-6 and IL-10 were the same at T0 and T240. At T60 and T240, the plasmatic albumin concentrations were 24 +/- 4 g/L and 23 +/- 4 g/L, respectively ( p = 0.13). Conclusions: In this animal model of endotoxinic shock, we confirm the high cytokine clearance observed when hemofiltration is applied to a large pore membrane. The loss of albumin seems negligible. The impact of such clearances on hemodynamic stability and survival remains to be proved.
Disciplines :
Laboratory medicine & medical technology
Author, co-author :
Delanaye, Pierre ; Centre Hospitalier Universitaire de Liège - CHU > Néphrologie
Lambermont, Bernard ; Centre Hospitalier Universitaire de Liège - CHU > Frais communs médecine
Dogné, Jean-Michel ; Université de Liège - ULiège > Département de pharmacie > Département de pharmacie
Dubois, Bernard ; Centre Hospitalier Universitaire de Liège - CHU > Néphrologie
Ghuysen, Alexandre ; Université de Liège - ULiège > Département des sciences de la santé publique > Réanimation - Urgence extrahospitalière
Janssen, Nathalie ; Centre Hospitalier Universitaire de Liège - CHU > Urgences
Desaive, Thomas ; Université de Liège - ULiège > Département d'astrophys., géophysique et océanographie (AGO) > Thermodynamique des phénomènes irréversibles
Kolh, Philippe ; Université de Liège - ULiège > Département des Sciences biomédicales et précliniques > Service de Biochimie et Physiologie
D'Orio, Vincenzo ; Université de Liège - ULiège > Département des sciences cliniques > Médecine d'urgence - bioch. et phys. hum. normales et path.
Krzesinski, Jean-Marie ; Université de Liège - ULiège > Département des sciences cliniques > Néphrologie
Language :
English
Title :
Confirmation of high cytokine clearance by hemofiltration with a cellulose triacetate membrane with large pores: an in vivo study
Friedman G, Silva E, Vincent JL. Has the mortality of septic shock changed with time. Crit Care Med 1998; 26: 2078-86.
Parrillo JE. Pathogenetic mechanisms of septic shock. N Engl J Med 1993; 328: 1471-7.
Simmons EM, Himmelfarb J, Sezer MT, et al. Plasma cytokine levels predict mortality in patients with acute renal failure. Kidney Int 2004; 65: 1357-65.
Journois D, Israel-Biet D, Pouard P, et al. High-volume, zero-balanced hemofiltration to reduce delayed inflammatory response to cardiopulmonary bypass in children. Anesthesiology 1996; 85: 965-76.
Groeneveld AB. Septic shock and multiple organ failure: treatment with haemofiltration? Intensive Care Med 1990; 16: 489-90.
Ronco G, Tetta C, Mariano F, et al. Interpreting the mechanisms of continuous renal replacement therapy in sepsis: the peak concentration hypothesis. Artif Organs 2003; 27: 792-801.
De Vriese AS, Colardyn FA, Philippe JJ, Vanholder RC, De Sutter JH, Lameire NH. Cytokine removal during continuous hemofiltration in septic patients. J Am Soc Nephrol 1999; 10: 846-53.
Heering P, Morgera S, Schmitz FJ, et al. Cytokine removal and cardiovascular hemodynamics in septic patients with continuous venovenous hemofiltration. Intensive Care Med 1997; 23: 288-96.
Kellum JA, Johnson JP, Kramer D, Palevsky P, Brady JJ, Pinsky MR. Diffusive vs. convective therapy: effects on mediators of inflammation in patient with severe systemic inflammatory response syndrome. Crit Care Med 1998; 26: 1995-2000.
Sander A, Armbruster W, Sander B, Daul AE, Lange R, Peters J. Hemofiltration increases IL-6 clearance in early systemic inflammatory response syndrome but does not alter IL-6 and TNF alpha plasma concentrations. Intensive Care Med 1997; 23: 878-84.
Pathan N, Hemingway CA, Alizadeh AA, et al. Role of interleukin 6 in myocardial dysfunction of meningococcal septic shock. Lancet 2004; 363: 203-9.
Marchant A, Deviere J, Byl B, De Groote D, Vincent JL, Goldman M. Interleukin-10 production during septicaemia. Lancet 1994; 343: 707-8.
Uchino S, Bellomo R, Goldsmith D, et al. Super high flux hemofiltration: a new technique for cytokine removal. Intensive Care Med 2002; 28: 651-5.
Morgera S, Haase M, Rocktaschel J, et al. High permeability haemofiltration improves peripheral blood mononuclear cell proliferation in septic patients with acute renal failure. Nephrol Dial Transplant 2003; 18: 2570-6.
Gohl H, Buck R, Strathmann H. Basic features of the polyamide membranes. Contrib Nephrol 1992; 96: 1-25.
Morgera S, Klonower D, Rocktaschel, J et al. TNF-alpha elimination with high cut-off haemofilters: a feasible clinical modality for septic patients? Nephrol Dial Transplant 2003; 18: 1361-9.
Uchino S, Bellomo R, Goldsmith D, et al. Cytokine removal with a large pore cellulose triacetate filter: an ex vivo study. Int J Artif Organs 2002; 25: 27-32.
Lambermont B, Kolh P, Detry O, Gerard P, Marcelle R, D'Orio V. Analysis of endotoxin effects on the intact pulmonary circulation. Cardiovasc Res 1999; 41: 275-81.
Webb LM, Ehrengruber MU, Clark-Lewis I, Baggiolini M, Rot A. Binding to heparan sulfate or heparin enhances neutrophil responses to interleukin 8. Proc Natl Acad Sci U S A 1993; 90: 7158-62.
Morgera S, Slowinski T, Melzer C, et al. Renal replacement therapy with high-cutoff hemofilters: Impact of convection and diffusion on cytokine clearances and protein status. Am J Kidney Dis 2004; 43: 444-53.
Lee WC, Uchino S, Fealy N, et al. Super high flux hemodialysis at high dialysate flows: an ex vivo assessment. Int J Artif Organs 2004; 27: 24-8.
Morgera S, Rocktaschel J, Haase M, et al. Intermittent high permeability hemofiltration in septic patients with acute renal failure. Intensive Care Med 2003; 29: 1989-95.
Mariano F, Fonsato V, Lanfranco G, et al. Tailoring high-cut-off membranes and feasible application in sepsis-associated acute renal failure: in vitro studies. Nephrol Dial Transplant 2005; 20: 1116-26.
Lonnemann G, Koch KM, Shaldon S, Dinarello CA. Studies on the ability of hemodialysis membranes to induce, bind, and clear human interleukin-1. J Lab Clin Med 1988; 112: 76-86.
Goldfarb S, Golper TA. Proinflammatory cytokines and hemofiltration membranes. J Am Soc Nephrol 1994; 5: 228-32.
Honore PM, Matson JR. Hemofiltration, adsorption, sieving and the challenge of sepsis therapy design. Crit Care 2002; 6: 394-6.
Wingfield P, Pain RH, Craig S. Tumour necrosis factor is a compact trimer. FEBS Lett 1987; 211: 179-84.
Di Carlo JV, Alexander SR. Hemofiltration for cytokine-driven illnesses: the mediator delivery hypothesis. Int J Artif Organs 2005; 28: 777-86.
Honore PM, Joannes-Boyau O. High volume hemofiltration (HVHF) in sepsis: a comprehensive review of rationale, clinical applicability, potential indications and recommendations for future research. Int J Artif Organs 2004; 27: 1077-82.
Lee PA, Weger GW, Pryor RW, Matson JR. Effects of filter pore size on efficacy of continuous arteriovenous hemofiltration therapy for Staphylococcus aureus-induced septicemia in immature swine. Crit Care Med 1998; 26: 730-7.