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NDT Advance Access originally published online on December 2, 2008
Nephrology Dialysis Transplantation 2009 24(2):354-357; doi:10.1093/ndt/gfn666
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Are the synergistic effects of high-volume haemofiltration and enhanced adsorption the missing key in sepsis modulation?*

Olivier Joannes-Boyau1, Patrick M. Honore2, Willem Boer3 and Vincent Collin4

1 Anaesthesia and Intensive Care Department II, University Hospital of Bordeaux, University of Bordeaux II, Pessac, France 2 St-Pierre Para-Universitary Hospital, Ottignies-Louvain-La-Neuve, Belgium 3 Atrium Medical Center, Heerlen, The Netherlands 4 Clinique de L'Europe, Brussels, Belgium

Correspondence and offprint requests to: Patrick M. Honore, St-Pierre Para-Universitary Hospital, Ottignies-Louvain-La-Neuve, Belgium. Tel: +32-10-437346; Fax: +32-10-437123; E-mail: Pa.honore@clinique-saint-pierre.be; Pathonor@skynet.be

Keywords: acute kidney injury; adsorption; haemofiltration; sepsis; septic shock

The first 150 words of the full text of this article appear below.



   Introduction
 
Despite major recent therapeutic improvements, septic shock remains a leading cause of mortality in intensive care patients [1]. For more than a decade, it has been advocated [2,3] that the reduction of blood cytokine levels could, at least theoretically, lead to reduced mortality. However, in view of the complexity of the pharmacodynamics and pharmacokinetics of cytokines, this concept seems too oversimplified to apply. In this issue of the journal, Rimmelé and co-authors attempt to demonstrate that high-volume haemofiltration (HVHF) with enhanced adsorption (EA) can modulate and ameliorate sepsis-induced haemodynamical instability [4]. It is suggested in this paper that membranes with EA are key and that increased extraction from the central circulation is sufficient to obtain a beneficial clinical effect. It seems at least theoretically reasonable that effective removal of mediators from the tissue, where they are harmful, and transporting them to the central circulation . . . [Full Text of this Article]


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