Renal replacement therapy in acute renal failure is currently focused on the use of modifications of dialysis (continuous arteriovenous hemofiltration and hemodiafiltration) to remove middle molecular weight toxins, consisting of small proteins, and cytokines involved in the systemic inflammatory response syndrome (SIRS). Conventional high-flux dialyzers are not efficient at removing these molecules, prompting the investigation of sorbents to augment or replace dialysis. Sorbents have been developed to modulate SIRS by targeting cytokines such as IL-1, IL-6, IL-10, IL-18 and TNF, among others. Extensive pre-clinical studies are underway to demonstrate the clinical utility and safety of either adding sorbent hemoadsorption devices to hemodialysis, or the use of such devices alone in SIRS, sepsis, acute renal failure, cardiopulmonary bypass and end-stage renal disease.
© 2003 S. Karger AG, Basel
- Acute renal failure
- Systemic inflammatory response syndrome
- Chronic renal failure
- Kennedy AC, Burton JA, Luke RG, Briggs JD, Lindsay RM, Allison ME, Edward N, Dargie HJ: Factors affecting the prognosis in acute renal failure. A survey of 251 cases. Q J Med 1973;42:73–86.
- Clermont G, Acker CG, Angus DC, Sirio CA, Pinsky MR, Johnson JP: Renal failure in the ICU: Comparison of the impact of acute renal failure and end-stage renal disease on ICU outcomes. Kidney Int 2002;62:986–996.
- Ronco C, Bellomo R, Homel P, Brendolan A, Dan M, Piccinni P, La Greca G: Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: A prospective randomised trial. Lancet 2000;356:26–30.
- Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR: Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome and associated costs of care. Crit Care Med 2001;29:1303–1310.
- Standiford TJ, Strieter RM, Lukacs NW, Kunkel SL: Neutralization of IL-10 increases lethality in endotoxemia. J Immunol 1995;155:2222–2229.
- Ash SR, Steczko J, Levy H, Blake DE, Carr DJ: Treatment of systemic inflammatory response syndrome by push-pull powdered sorbent pheresis: A phase 1 clinical trial. Ther Apher 2001;5:497–505.
- Peter AT, Ash SR, Steczko J, Turek JJ, Blake DE, Carr DJ, Knab WR, Bosley RH: Push-pull sorbent-based pheresis treatment in an experimental canine endotoxemia model: Preliminary report. Int J Artif Organs 1999;22:177–188.
- Ronco C, Brendolan A, Lonnemann G, Bellomo R, Piccinni P, Digito A, Dan M, Irone M, La Greca G, Inguaggiato P, Maggiore U, De Nitti C, Wratten ML, Ricci Z, Tetta C: A pilot study of coupled plasma filtration with adsorption in septic shock. Crit Care Med 2002;30:1250–1255.
- Ronco C, Brendolan A, Dan M, Piccinni P, Bellomo R, De Nitti C, Inguaggiato P, Tetta C: Adsorption in sepsis. Kidney Int Suppl 2000;76:S148–S155.
- Tetta C, Bellomo R, Formica M, Livigni S, Mariano F, Wratten ML, Carraro G, Ronco C: Use of adsorbents in ARF therapy. Contrib Nephrol. Basel, Karger, 2002, vol 137, pp 181–188.
- Uriu K, Osajima A, Hiroshige K, Watanabe H, Aibara K, Inada Y, Segawa K, Anai H, Takagi I, Ito A, Kamochi M, Kaizu K: Endotoxin removal by direct hemoperfusion with an adsorbent column using polymyxin B-immobilized fiber ameliorates systemic circulatory disturbance in patients with septic shock. Am J Kidney Dis 2002;39:937–947.
- Uriu K, Osajima A, Kamochi M, Watanabe H, Aibara K, Kaizu K: The severity of hyperdynamic circulation may predict the effects of direct hemoperfusion with the adsorbent column using polymyxin B-immobilized fiber in patients with Gram-negative septic shock. Ther Apher 2001;5:25–30.
- McCuskey RS, Urbaschek R, Urbaschek B: The microcirculation during endotoxemia. Cardiol Res 1996;32:752–763.
- Koj A: Initiation of acute phase response and synthesis of cytokines. Biochim Biophys Acta 1996;1317:84–94.
- Melnikov VY, Ecder T, Fantuzzi G, Siegmund B, Lucia MS, Dinarello CA, Schrier RW, Edelstein CL: Impaired IL-18 processing protects caspase-1-deficient mice from ischemic acute renal failure. J Clin Invest 2001;107:1145–1152.
- Oberholzer A, Steckholzer U, Kurimoto M, Trentz O, Ertel W: Interleukin-18 plasma levels are increased in patients with sepsis compared to severely injured patients. Shock 2001;16:411–414.
- Pinsky MR, Vincent JL, Deviere J, Alegre M, Kahn RJ, Dupont E: Serum cytokine levels in human septic shock. Relation to multiple-system organ failure and mortality. Chest 1993;103:565–575.
- Thijs A, Thijs LG: Pathogenesis of renal failure in sepsis. Kidney Int 1998;53:S34–S37.
- Davankov V, Pavlova L, Tsyurupa M, Brady J, Balsamo M, Yousha E: Polymeric adsorbent for removing toxic proteins from blood of patients with kidney failure. J Chromatogr B Biomed Sci Appl 2000;739:73–80.
- Mertens PR, Schonfelder T, Handt S, Kierdorf H, Marschall H, Busch N, Heintz B, Sieberth H: Long-term extracorporeal bilirubin elimination: A case report on cascade resin plasma perfusion. Blood Purif 1998;16:341–348.
- Sato T, Orlowski JP, Zborowski M: Experimental study of extracorporeal perfusion for septic shock. ASAIO J 1993;39:M790–M793.
- Pond SM: Extracorporeal techniques in the treatment of poisoned patients. Med J Aust 1991;154:617–622.
- Ronco C, Brendolan A, Winchester JF, Golds E, Clemmer J, Polaschegg HD, Muller TE, Davankov V, Tsyurupa M, Pavlova L, Pavlov M, La Greca G, Levin NW: First clinical experience with an adjunctive hemoperfusion device designed specifically to remove β2-microglobulin in hemodialysis. Contrib Nephrol. Basel, Karger, 2001, vol 133, pp 166–173.
- Ronco C, Brendolan A, Dan M, Piccinni P, Bellomo R, Wratten ML, Inguaggiato P, Tetta C: Use of sorbents in acute renal failure and sepsis. Contrib Nephrol. Basel, Karger, 2001, vol 133, pp 180–193.
- Brendolan A, Irone M, Digno A, Cioffi M, Piccinni P, Dan M, Tetta C, Ronco C: Coupled plasma filtration-adsorption technique in sepsis-associated acute renal failure. J Am Soc Nephrol 1998;9:127A.
- Levy H, Ash SR, Knab W, Steczko J, Carr DJ, Blake DE: Systemic inflammatory response syndrome treatment by powdered sorbent pheresis: The BioLogic-Detoxification Plasma Filtration System. ASAIO J 1998;44:M659–M665.
- Nakamura T, Ebihara I, Shimada N, Koide H: Changes in plasma erythropoietin and interleukin-6 concentrations in patients with septic shock after hemoperfusion with polymyxin B-immobilized fiber. Intensive Care Med 1998;24:1272–1276.
- Winchester JF, Ronco C, Brady JA, Cowgill LD, Salsberg J, Yousha Y, Choquette M, Albright R, Clemmer J, Davankov V, Tsyurupa M, Pavlova L, Pavlov M, Cohen G, Horl W, Gotch F, Levin N: The next step from high-flux dialysis: Application of sorbent technology. Contrib Nephrol. Basel, Karger, 2002, vol 137, pp 170–180.
- Brady JA, Potempska A, Ronco C, Yousha E, Muller T, Levin N: Ex vivo cytokine clearance with a new adsorbent material from endotoxin-stimulated whole blood. J Am Soc Nephrol 2000;11:586A.
- Kellum JA, Song M, Venkataraman R, et al: Improved survival with hemoadsorption in endotoxin-induced shock in rats (abstract). Am J Respir Crit Care Med 2002;165:A176.
- Morena MD, Guo D, Balakrishnan VS, Brady JA, Winchester JF, Jaber BL: Effect of the Betasorb™ perfusion column on the bioreactivity of uremic plasma. ASAIO J 2002;48:178.
- Stegmayr B: Apheresis of plasma compounds as a therapeutic principle in severe sepsis and multiorgan dysfunction syndrome. Clin Chem Lab Med 1999;37:327–332.
- Nguyen TC, Hall MW, Han YY: Randomized controlled trial of plasma exchange therapy for thrombocytopenia-associated multiple organ failure in children (abstract). Pediatr Res 2001;49:42A.
- Cole L, Bellomo R, Hart G, Journois D, Davenport P, Tipping P, Ronco C: A phase II randomized, controlled trial of continuous hemofiltration in sepsis. Crit Care Med 2002;30:100–106.
- De Vriese AS, Vanholder RC, Pascual M, Lameire NH, Colardyn FA: Can inflammatory cytokines be removed efficiently by continuous renal replacement therapies? Intensive Care Med 1999;25:903–910.
- Kellum JA, Song M, Venkataraman R, et al: Improved survival with hemadsorption in endotoxin induced shock in rats. Abstr Am J Respir Crit Care Med 2002;165:A176.
- Kellum JA: Immunomodulation in sepsis: The role of hemofiltration. Minerva Anestesiol 1999;65:410–418.
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Number of Figures : 2, Number of Tables : 2, Number of References : 37
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