BACKGROUND: Renal replacement therapies with high cut-off haemofilters are new approaches in the adjuvant therapy of @entity295 . We analysed the cytokine elimination capacity of a newly developed polyflux high cut-off haemofilter. Different renal replacement therapies are compared and tested for their clinical feasibility. METHODS: Blood from healthy volunteers (n=15) was incubated for 4 h with 1 mg of endotoxin and then circulated through a closed extracorporeal circuit. A newly developed polyflux haemofilter (P2SX) was used. Haemofiltration, haemodialysis and albumin dialysis were tested. @entity1193 (17 kDa), @entity650 ( @entity650 ) (28 kDa), @entity5 necrosis factor alpha ( @entity310 ) (51 kDa), albumin (64 kDa), creatinkinase (CK) (80 kDa) and IgG (140 kDa) were measured in blood and filtrates prior to the initiation and after 5 min, 1, 2 and 4 h. RESULTS: Haemofiltration was superior to haemodialysis in the clearance capacity of all substances when applied in the 1 l/h ultrafiltration mode. Increasing the ultrafiltration rate/dialysate flow from 1 to 3 l/h led to a significant increase in cytokine clearances (P<0.001). At 3 l/h the differences between haemofiltration and haemodialysis vanished and both techniques achieved comparable cytokine clearances. Median clearance values ranged between 25 and 54 ml/min for @entity1193 ( @entity1193 ), 23 and 42 ml/min for @entity650 and 15 and 28 ml/min for @entity310 . Albumin loss was highest in the haemofiltration group with albumin clearances ranging between 7 and 13 ml/min. Using diffusion instead of convection significantly reduced the loss of albumin (P<0.01 for 1 l/h, P<0.05 for 3 l/h). Albumin dialysis was able to completely inhibit albumin loss but cytokine clearance capacity was limited. CONCLUSIONS: High cut-off haemofilters achieve high clearances for inflammatory @entity650 and @entity310 . Due to the high protein loss in haemofiltration, dialysis in combination with balanced protein substitution seems to be a suitable approach for clinical trials.

XXXX elimination with high cut-off haemofilters: a feasible clinical modality for septic patients?

@entity650 :: ('3569', 'Gene') :: ['IL-6', 'interleukin-6'] @entity295 :: ('MESH:D018805', 'Disease') :: ['sepsis'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumour'] @entity310 :: ('7124', 'Gene') :: ['TNF-alpha'] @entity1193 :: ('3557', 'Gene') :: ['IL-1ra', 'interleukin-1 receptor antagonist']
@entity310 :: (7124,Gene) :: ['TNF-alpha']
