Evidence-based analysis of the role of hemofiltration in sepsis and multiorgan dysfunction syndrome

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Abstract
Hemofiltration has been suggested to exert a beneficial effect on sepsis and other inflammatory syndromes by extracorporeal elimination of inflammatory mediators. However, the characteristics of most inflammatory mediators (limited presence in plasma water, high endogenous clearance and production) make clinically important elimination unlikely. In vitro studies show limited convection and saturable membrane absorption of proinflammatory cytokines, generally considered as major inflammatory mediators. Most experimental and clinical studies do not show an effect of hemofiltration on the plasma levels of these cytokines. Although some animal studies show a beneficial effect of hemofiltration on the survival of experimental sepsis, this effect is not confirmed but neither excluded by randomized clinical trials. Animal studies suggest the elimination of a myocardial depressant substance. The beneficial effect on hemodynamic parameters is most pronounced if high filtration rates are used. A limited number of small controlled clinical trials on the other hand demonstrate an attenuation of the hyperdynamic response. Evidence for a beneficial effect of zero-balanced hemofiltration on gas exchange is limited. More controlled trials are needed before the widespread use of hemofiltration in sepsis can be recommended

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