Vol. 22, No. 1, 2004
Issue release date: 2004
Blood Purif 2004;22:164–174
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Extracorporeal Therapies in Non-Renal Disease: Treatment of Sepsis and the Peak Concentration Hypothesis

Ronco C.a · Bonello M.a · Bordoni V.a · Ricci Z.a · D’Intini V.a · Bellomo R.b · Levin N.W.c
aDepartment of Nephrology, St. Bortolo Hospital, Vicenza, Italy; bDepartment of Intensive Care, Austin & Repatriation Medical Center, Heidelberg, Vic., Australia; cRenal Research Institute and Beth Israel Medical Center, New York, N.Y., USA
email Corresponding Author

 goto top of outline Key Words

  • Continuous renal replacement therapy
  • Counter anti-inflammatory response
  • Immunodysregulation
  • Peack concentration hypothesis
  • Sepsis
  • Systemic inflammatory syndrome

 goto top of outline Abstract

In the setting of intensive care, patients with acute renal failure often present a clinical picture of the systemic inflammatory response syndrome (SIRS). SIRS can be caused by bacterial stimuli or by non-microbiological stimuli that induce a significant inflammatory response. When this response is exaggerated, the patient experiences multiple organ system failure and a condition of sepsis also defined as a systemic malignant inflammation. This is mostly characterized by an invasion of cytokines and other pro-inflammatory mediators into the systemic circulation where major biological effects take place, including vasopermeabilization, hypotension and shock. At the same time, the monocyte of the septic patient seems to be hyporesponsive to inflammatory stimuli to a certain extent. In this condition, the patient faces a situation of hyperinflammation but at the same time of immunodepression expressing a clinical entity defined as counter anti-inflammatory response syndrome. The general picture of the clinical disorder is therefore better characterized by an immunodysregulation than by a simple pro- or anti-inflammatory disorder. Due to the short half-life of cytokines and other mediators spilled over into the circulation, it is extremely difficult to approach the problem at the right moment with the right pharmacological agent. For these reasons, the peak concentration hypothesis suggests that continuous renal replacement therapies, due to their continuity and unspecific capacity of removal, might be beneficial in cutting the peaks of the concentrations of both pro- and anti-inflammatory mediators, restoring a situation of immunohomeostasis. Thus the patient may benefit from a lesser degree of immunodysregulation and he/she may restore a close-to-normal capacity of response to exogenous stimuli.

Copyright © 2004 S. Karger AG, Basel

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 goto top of outline Author Contacts

Claudio Ronco, MD
Director of the Department of Nephrology
St. Bortolo Hospital, Viale Rodolfi
IT–36100 Vicenza (Italy)
Tel. +39 044 499 3869, Fax +39 044 499 3949, E-Mail cronco@goldnet.it

 goto top of outline Article Information

Number of Print Pages : 11
Number of Figures : 3, Number of Tables : 0, Number of References : 92

 goto top of outline Publication Details

Blood Purification
Founded 1983; edited by K. Schaefer (1983–1988)
Official Journal of the International Society of Blood Purification and the Vascular Access Society (VAS)

Vol. 22, No. 1, Year 2004 (Cover Date: 2004)

Journal Editor: K.M.L. Leunissen, Maastricht
ISSN: 0253–5068 (print), 1421–9735 (Online)

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