NDT Advance Access published online on September 17, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn518
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High-volume haemofiltration with a new haemofiltration membrane having enhanced adsorption properties in septic pigs
1 Department of Anesthesiology and Intensive Care, Pavilion P, Édouard Herriot Hospital 2 INSERM ERI 22, Agressions vasculaires-Réponses tissulaires 3 University of Lyon 1 4 Gambro-Hospal Industries 5 Laboratory of Biochemistry 6 Laboratory of Microbiology, Édouard Herriot Hospital, Lyon, France
Correspondence and offprint requests to: Thomas Rimmelé, Département d’Anesthésie-Réanimation, Pavillon P Réanimation, Hôpital Édouard Herriot, place d’Arsonval, 69003 Lyon, France. Tel: +33-472-110-217; Fax: +33-472-110-275; E-mail: thmrimmele{at}aol.com
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Abstract |
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Background. High-volume haemofiltration (HVHF) has been suggested as an adjuvant treatment of septic shock due to its capacities to remove from blood both pro- and anti-inflammatory mediators involved in the sepsis syndrome. Adsorption properties of some haemofiltration membranes are also interesting with this indication because inflammatory mediators are caught in the membrane itself. The aim of this study was to determine the haemodynamic and immunological effects of a new haemofiltration membrane, which has enhanced adsorption properties due to a special surface treatment, allowing the adsorption of endotoxins.
Methods. We compared this membrane to a standard haemofiltration membrane both in vitro and in 20 sepsis-induced pigs, randomized in two groups. One group was haemofiltered with the treated membrane and the other with the standard haemofiltration membrane during 6-h HVHF sessions.
Results. At the end of the experiment, mean ± SD crystalloids requirements (5937 ± 1588 versus 7587 ± 1456 ml, P = 0.026), colloids requirements (1437 ± 320 versus 1912 ± 538 ml, P = 0.027), lactic acidosis (pH = 7.20 ± 0.11 versus 7.10 ± 0.07, P = 0.026) and pulmonary arterial hypertension (MPAP = 24 ± 7 versus 34 ± 8 mmHg, P = 0.008) were less pronounced when HVHF was performed with the treated membrane. In addition, mean ± SD endotoxins levels were lower in the treated membrane group after 1 hour of HVHF (1.91 ± 1.19 versus 11.07 ± 10.64 EU/ml, P = 0.035). Cytokines levels were not different between groups except for IL-1β, which was slightly lower in the treated membrane group.
Conclusions. The use of a membrane with enhanced adsorption properties during a 6-h HVHF session in septic pigs improves haemodynamics compared to a standard haemofiltration membrane. These results are probably due to an efficient endotoxins and cytokines adsorption. A human study using this membrane is now necessary to confirm these results.
Keywords: adsorption; cytokine; endotoxin; high-volume haemofiltration; septic shock
Received for publication: 25. 4.08
Accepted in revised form: 22. 8.08