Clinical trial NCT00490477: The Effects of Polymyxin-B Protects on Sepsis Induced Kidney Dysfunction: a Randomized Clinical Trial
Official title: Polymyxin-B Hemoperfusion Inactivates Circulating Proapoptotic Factors
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE3
Conditions: Gram-Negative Bacterial Infections
Sepsis
Keywords: acute renal failure
lipopolysaccharide
tubular apoptosis
Polymyxin-B fiber
Severe sepsis from gram negative infection
Lead sponsor: University of Turin, Italy
Sponsor class: OTHER
First posted: 2007-06-22
Enrollment: 16
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: PREVENTION

Brief summary: Aim of the study is to verify whether Polymyxin-B hemoperfusion protects from renal dysfunction in patients with severe sepsis from gram negative infection.

Detailed description: Acute renal failure (ARF) is a frequent complication in sepsis, in nearly to 50% of the cases, and the mortality rate is higher, compare to patients with ARF alone (70% vs 45%). Clinical and experimental studies demonstrated the key role of apoptosis, or programmed cell death, in the induction of tubular and glomerular injury in the course of sepsis. Indeed, it has been shown that inflammatory cytokines and lipopolysaccharide (LPS) cause renal tubular cell apoptosis via Fas- and caspase-mediated pathways. In addition, LPS is able to alter the normal expression pattern of sodium, urea and glucose renal transporters and to modulate tubular polarity by changing the expression of tight junction proteins with consequent back-leakage of tubular fluid in the interstitial spaces and enhancement of the inflammatory process. Therefore a novel extracorporeal therapy to remove circulating LPS, using the Polymyxin-B fiber (PMX-B) cartridge was developed. The PMX-B cartridge is an extracorporeal hemoperfusion device and consists of a polystyrene-based, fibrous adsorbent on which the polymyxin B antibiotic is covalently immobilized as a ligand to adsorb endotoxin.

Aim of this study is to verify whether the removal of LPS, using the PMX-B hemoperfusion system, protects from acute renal failure, reduces the need for Renal Replacement Therapy (RRT) and consequently improves the outcome in severe sepsis from gram negative infection.

Eligibility criteria: Inclusion Criteria:

* Endotoxemia associated to severe sepsis

Exclusion Criteria:

* Age \< 18 years old
* Organ transplantation
* Hemorrhagic shock
* Thrombophilia
* Chronic renal failure
* Cardiogenic shock
* APACHE II score \> 30
* Lack of consent

Primary outcomes:
measure: Number of Participants Not Requiring Renal Replacement Therapy (RRT)
timeFrame: 28 days from the admission
Secondary outcomes:
measure: The Reduction of the Number of Apoptotic Cells, Stimulated With Plasma Derives From Septic Patients With Gram Negative Infection, Treated With PMX-B Hemoperfusion, on Immortalized Tubular and Glomerular Cell Cultures.
timeFrame: 72 hours after randomization
Other outcomes:
Locations:
city: Turin
country: Italy
facility: University of Turin, Department of anesthesia and Intensive Care Medicine
Study officials:
affiliation: University of Turin, Department of Anesthesia and Intensive Care Medicine
name: marco ranieri, MD
role: STUDY_DIRECTOR
affiliation: University of Turin, Department of Anesthesia and Intensive Care Medicine
name: marco ranieri, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Cantaluppi V, Assenzio B, Pasero D, Romanazzi GM, Pacitti A, Lanfranco G, Puntorieri V, Martin EL, Mascia L, Monti G, Casella G, Segoloni GP, Camussi G, Ranieri VM. Polymyxin-B hemoperfusion inactivates circulating proapoptotic factors. Intensive Care Med. 2008 Sep;34(9):1638-45. doi: 10.1007/s00134-008-1124-6. Epub 2008 May 8.