Plasmatic cytokines and intermittent hemodialysis with polymethylmethacrylate membrane in septic shock patients
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KeywordsPMMA Polymethylmethacrylate Acute Renal Failure Renal Replacement Therapy Sequential Organ Failure Assessment
Sepsis is mediated by many biologically active inflammatory mediators, including interleukins. IL-6, IL-8, and IL-10 *P < 0.05. are correlated with increased mortality in septic shock acute renal failure (ARF) . ARF treatment requires renal replacement therapy (RRT). The cytokine plasmatic level during and after hemodialysis (HD) in septic ARF is partially described . Polymethylmethacrylate (PMMA) hemodialyser membranes own high adsorptive capacity . In this prospective observational trial, we study the plasmatic level of IL-6, IL-8 and IL-10 during and after the first HD seance with PMMA membrane in septic shock patients with ARF.
Inclusion criteria: patients with septic shock <24 hours as defined by the American College of Chest Physicians/Society of Critical Care Medecine and requiring RRT (Injury in the RIFLE criteria). The hemodialyser PMMA membrane was Filtrizer BK-1,6 F (TORAY Industrie, Tokyo, Japan). Data and blood samples were collected at: start of HD (D0), every hour during HD (D1; D2), at the end of HD (endD); and 30, 60, 90, 120 and 180 minutes after HD (postD0.5; postD1; postD1.5; postD2; postD3, respectively). Solid-phase ELISA was used for cytokine measurements. Statistical analysis was by Kruskall–Wallis nonparametric test.
PMMA membranes showed transient efficiency in IL-8 and IL-10 elimination by possible membrane saturation. The IL-6 concentration was not modified. Three hours after HD, the IL-8 and IL-10 concentrations were back to baseline. This fast increase could be explained by plasmatic rebound and must be kept in mind. This rebound could be deleterious in this stage of sepsis.
This article is published under license to BioMed Central Ltd.