Nephrol Dial Transplant (2002) 17: 1950-1956
© 2002 European Renal Association-European Dialysis and Transplant Association
The effect of coupled haemofiltration and adsorption on inflammatory cytokines in an ex vivo model
1 Department of Intensive Care, Austin and Repatriation Medical Centre, Heidelberg, Victoria, 2 Department of Medicine, Monash Medical Centre, Melbourne, Australia, 3 Bellco Spa, Mirandola, Italy and 4 Department of Nephrology, S. Bortolo Hospital, Vicenza, Italy
Background. The objective of this study was to evaluate the ex vivo removal of cytokines with an extracorporeal circuit using coupled large-pore haemofiltration and sorbent adsorption.
Methods. The setting for this study was a laboratory attached to the Intensive Care Unit of a tertiary hospital. Six healthy volunteers donated blood, which was incubated with endotoxin. Control blood was left at room temperature. Treatment blood was recirculated for 6 h through a closed circuit with a large-pore polysulfone haemofilter (average pore size 150 kDa) and an activated charcoal cartridge. Blood and ultrafiltrate were sampled hourly from three sites (pre-haemofilter for the circulating concentration, at cartridge inlet and cartridge outlet) to measure the concentrations of interleukins (IL)-1ß, -6, -8 and -10, and tumour necrosis factor (TNF).
Results. Control cytokine concentrations remained the same or increased slightly. Most of the preformed circuit cytokines were removed, with the exception of IL-10. The average sieving coefficients were 0.61 for IL-1ß, 1.34 for IL-6, 0.30 for IL-8, and 0.56 for TNF. Average single-pass clearances were 49, 107, 24 and 45 ml/min, respectively. The cartridge adsorbed 90% of IL-1ß, 72% of IL-6, 100% of IL-8, and 7% of TNF during each pass.
Conclusion. The combination of a large-pore haemofilter and charcoal cartridge removed several cytokines efficiently under ex vivo conditions. This technique can now be tested for cytokine removal in vivo.
Keywords: adsorption; charcoal cartridge; ex vivo model; haemofiltration; inflammatory cytokines
Correspondence and offprint requests to: Associate Professor Rinaldo Bellomo, Department of Intensive Care, Austin and Repatriation Medical Centre, Heidelberg, Victoria, 3084 Australia. Email: rinaldo.bellomo{at}armc.org.au
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