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

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Abstract
Background. Renal replacement therapies with high cut‐off haemofilters are new approaches in the adjuvant therapy of sepsis. 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. IL‐1ra (17 kDa), interleukin‐6 (IL‐6) (28 kDa), tumour necrosis factor alpha (TNF‐α) (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 (PPPConclusions. High cut‐off haemofilters achieve high clearances for inflammatory IL‐6 and TNF‐α. Due to the high protein loss in haemofiltration, dialysis in combination with balanced protein substitution seems to be a suitable approach for clinical trials.