Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/10419
Title: Hemodialysis membrane with a high-molecular-weight cutoff and cytokine levels in sepsis complicated by acute renal failure: a phase 1 randomized trial.
Authors: Haase, Michael;Bellomo, Rinaldo;Baldwin, Ian;Haase-Fielitz, Anja;Fealy, Nigel;Davenport, Piers;Morgera, Stanislao;Goehl, Hermann;Storr, Markus;Boyce, Neil;Neumayer, Hans-Hellmut
Affiliation: Intensive Care Unit, Austin Hospital, University of Melbourne, Australia.
Issue Date: 1-Aug-2007
Citation: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation; 50(2): 296-304
Abstract: Sepsis is the leading cause of acute renal failure. Intermittent hemodialysis (IHD) is a common treatment for patients with acute renal failure. However, standard hemodialysis membranes achieve only little diffusive removal of circulating cytokines. Modified membranes may enable both successful IHD treatment and simultaneous diffusive cytokine removal.Double-blind, crossover, randomized, controlled, phase 1 trial.Tertiary intensive care unit. 10 septic patients with acute renal failure according to RIFLE class F.Each patient was treated with 4 hours of high-cutoff (HCO)-IHD and 4 hours of high-flux (HF)-IHD.We chose relative change in plasma interleukin 6 (IL-6) concentrations from baseline to 4 hours as the primary outcome for effective cytokine removal. We measured plasma and effluent concentrations of cytokines (IL-6, IL-8, IL-10, and IL-18) and albumin.Median age was 53 years (25(th) to 75(th) percentiles, 43 to 71 years). Both treatments achieved equal control of uremia. Four hours of HCO-IHD accomplished a greater decrease in plasma IL-6 levels (-30.3%) than 4 hours of HF-IHD (1.1%; P = 0.05). HCO-IHD, but not HF-IHD, achieved substantial diffusive clearance of several cytokines (IL-6, 14.1 mL/min; IL-8, 75.2 mL/min; and IL-10, 25.5 mL/min). Such clearance also was associated with greater relative decreases in plasma IL-8 and IL-10 levels in favor of HCO-IHD (P = 0.02, P = 0.04). We found significantly greater relative changes from prefilter to postfilter plasma IL-6, IL-8, and IL-10 values in favor of HCO-IHD (P = 0.02, P = 0.01, P < 0.01). During HCO-IHD, cumulative albumin loss into the effluent was 7.7 g (25(th) to 75(th) percentiles, 4.8 to 19.6) versus less than 1.0 g for HF-IHD (P < 0.01).Small phase 1 trial.In septic patients with acute renal failure, HCO-IHD achieved simultaneous uremic control and diffusive cytokine clearances and a greater relative decrease in plasma cytokine concentrations than standard HF-IHD.
Internal ID Number: 17660031
URI: http://ahro.austin.org.au/austinjspui/handle/1/10419
DOI: 10.1053/j.ajkd.2007.05.003
URL: http://www.ncbi.nlm.nih.gov/pubmed/17660031
Type: Journal Article
Subjects: Acute Kidney Injury.blood.etiology.therapy
Adult
Aged
Cross-Over Studies
Cytokines.blood
Double-Blind Method
Female
Humans
Male
Membranes, Artificial
Middle Aged
Renal Dialysis.instrumentation.standards
Sepsis.blood.complications.therapy
Appears in Collections:Journal articles

Files in This Item:
There are no files associated with this item.


Items in AHRO are protected by copyright, with all rights reserved, unless otherwise indicated.