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PubMed2006

Blood warming during hemofiltration can improve hemodynamics and outcome in ovine septic shock.

BACKGROUND: This study was designed to evaluate the effects of blood warming during hemofiltration on global and regional hemodynamics, plasma lactate, and 24-h survival during septic shock. METHODS: Twenty anesthetized and mechanically ventilated sheep underwent induction of peritonitis and, 4 h later, were treated by hemofiltration with (n = 10) or without (n = 10) blood warming. RESULTS: In the group without blood warming, body temperature decreased after starting hemofiltration and remained below baseline. In the other animals, body temperature stabilized at baseline level during hemofiltration and increased to a maximum of 40.8 degrees C thereafter. The group without warming experienced a decrease in blood pressure (from 90 mmHg to 38 mmHg) and cardiac output (from 4.0 l/min to 2.3 l/min). Metabolic acidosis and the increase in lactate were less marked when temperature was maintained. None of the animals without warming but all of the animals with warming survived to 16 h. CONCLUSIONS: Differences in temperature during hemofiltration resulted in striking differences in hemodynamics, metabolic acidosis, and survival rate in this clinically relevant experimental model of septic shock.

Acidosis, Lactic↗
PubMed2000

Pharmacokinetics of meropenem in intensive care unit patients receiving continuous veno-venous hemofiltration or hemodiafiltration.

OBJECTIVE: To evaluate an intravenous meropenem dosage regimen in adult intensive care patients with acute renal failure treated by continuous renal replacement therapy. DESIGN: A prospective, clinical study. SETTING: General intensive care unit of a university hospital. PATIENTS: Ten critically ill adult patients being treated with meropenem and receiving continuous veno-venous hemofiltration (hemofiltration rates, 1-2 L/hr) (n = 5) or continuous venovenous hemodiafiltration (hemofiltration rates, 1-1.5 L/hr; dialysis rates, 1-1.5 L/hr) (n = 5) via a polyacrylonitrile hollow fiber 0.9-m2 filter. INTERVENTIONS: Patients received a meropenem dose of 1 g iv every 12 hrs as a 5-min bolus. MEASUREMENTS AND MAIN RESULTS: Meropenem concentrations were measured by high-performance liquid chromatography in serum taken at timed intervals and in ultrafiltrate/dialysate to determine serum concentration-time profiles, derive pharmacokinetic variable estimates, and determine sieving coefficients and filter clearances. The serum concentrations were examined to see whether they were above the minimum inhibitory concentrations (MICs) for pathogens that may be encountered in intensive care patients. Serum concentrations exceeded 4 mg/L (MIC90 for Pseudomonas aeruginosa) during 67% of the dosage period in all patients. Sub-MIC90 concentrations were obtained in three patients immediately before treatment and in one patient 12 hrs after treatment. Mean (SD) (n = 10) pharmacokinetic variable estimates were as follows: elimination half-life, 5.16 hrs (1.83 hrs); volume of distribution, 0.35 L/kg (0.10 L/kg); and total clearance, 4.30 L/hr (1.38 L/hr). A sieving coefficient of 0.93 (0.06) (n = 9) indicated free flow across the filter. The fraction cleared by the extracorporeal route was 48% (13%) (n = 9), which is clinically important. CONCLUSIONS: A meropenem dose of 1g iv every 12 hrs provides adequate serum concentrations in the majority of patients receiving continuous veno-venous hemofiltration or continuous venovenous hemofiltration with a 0.9-m2 polyacrylonitrile filter at combined ultrafiltrate/dialysate flow rates of up to 3 L/hr. A lower dose would not be sufficient for the empirical treatment of potentially life-threatening infections in all patients.

Acute Kidney Injury↗
PubMed1999

Effects of long-term hemofiltration on circulating mediators and superoxide production during continuous endotoxin administration.

BACKGROUND: The purpose of this study was to test whether continuous hemofiltration eliminates cytokines and eicosanoids, or stimulates granulocyte function. METHODS: Nineteen pigs were divided into a control group (n = 7), a hemofiltration group (n = 7), and an extracorporeal circuit only group (n = 5). All animals received the same amount of intravenous endotoxin and resuscitation fluid. Zero-balanced hemofiltration was started 30 minutes after initiation of endotoxemia and continued throughout the experiment. Plasma endotoxin, tumor necrosis factor-alpha, eicosanoids, superoxide production, and other physiologic parameters were measured before challenge and at scheduled intervals thereafter. RESULTS: Eicosanoids were filtered but plasma concentrations were not reduced. Tumor necrosis factor-alpha was not filtered or adsorbed. There were no significant differences between groups in any measured parameters. CONCLUSION: Continuous hemofiltration could not efficiently remove tumor necrosis factor-alpha or eicosanoids. Also, continuous hemofiltration did not stimulate production of the proinflammatory mediators measured, nor improve respiratory distress.

6-Ketoprostaglandin F1 alpha↗
PubMed2003

Effect of prostacyclin on platelets, polymorphonuclear cells, and heterotypic cell aggregation during hemofiltration.

OBJECTIVES: Hemodialysis activates both platelets and leukocytes, which play a role in the development of multiple organ dysfunctions in critically ill patients. Prostacyclin inhibits both cell types. To examine the hypothesis that prostacyclin prevents cellular activation during clinical hemofiltration, we investigated the expression of activation markers on platelets and leukocytes using whole blood flow cytometry. DESIGN: Prospective, randomized, double-blind, controlled trial. SETTING: Intensive care unit. PATIENTS: A total of 24 consecutive, critically ill, mechanically ventilated patients with acute renal failure secondary to sepsis or major surgery. INTERVENTIONS: For anticoagulation during hemofiltration, patients received either unfractionated heparin or unfractionated heparin and prostacyclin (5 ng x kg(-1) x min(-1)). Anticoagulants were administered into the extracorporeal circuit before the hemofilter. Blood samples were obtained from an arterial catheter before hemofiltration and from the inlet and outlet lines of the extracorporeal circuit at 1 and 24 hrs during hemofiltration. MEASUREMENTS AND MAIN RESULTS: Expression of GP IIb-IIIa and P-selectin on adenosine diphosphate-activated platelets and platelet-leukocyte aggregation were significantly lower after the passage of blood through the hemofilter in patients receiving an extracorporeal infusion of prostacyclin plus heparin when compared with control patients receiving heparin only. There were no statistically significant differences in the expression of CD11b on leukocytes between the two groups. CONCLUSIONS: These findings suggest that prostacyclin reversibly inhibits platelet function by diminishing the expression of platelet fibrinogen receptors and P-selectin and reduces heterotypic platelet-leukocyte aggregation during clinical hemofiltration. However, prostacyclin fails to inhibit leukocyte activation at clinically relevant doses.

Acute Kidney Injury↗
PubMedDate not supplied

Rationale and experience with short daily hemofiltration.

Patients with end-stage renal disease (ESRD) have morbidity and mortality rates that are much higher than those found in the general population. The nonphysiologic nature of thrice-weekly hemodialysis may be partially responsible for the poor outcomes in this patient population. In response to the problems encountered with conventional hemodialysis schedules, a number of investigators have explored potential solutions to the problem. One such solution is to increase the time and/or frequency of hemodialysis. With this approach, ESRD patients have been observed to have better anemia management and blood pressure control, as well as improvements in quality of life. Hemodialysis is based on diffusion of solutes across a semipermeable membrane such that only small molecules are readily removed. Therefore a second solution has been to utilize hemofiltration instead of hemodialysis. Hemofiltration utilizes convective clearance of molecules, resulting in an improvement in the removal of larger solutes, much like the glomerular basement membrane of the kidney. Despite the accumulated evidence that thrice-weekly hemofiltration adds to the benefits seen with increasing hemodialysis time and/or frequency, the use of hemofiltration has been limited by the available technology, cost, and low access blood flows. However, current technological advances in equipment and access creation are addressing these problems. With these advances, a number of investigators have also explored the potential benefits of daily hemofiltration as a treatment option for ESRD. The preliminary results suggest that improvements in blood pressure, beta2-microglobulin (beta2M) levels, and quality of life are possible.

Appointments and Schedules↗
PubMed2005

The clearance of protein-bound solutes by hemofiltration and hemodiafiltration.

BACKGROUND: Hemofiltration in the form of continuous venovenous hemofiltration (CVVH) is increasingly used to treat acute renal failure. Compared to hemodialysis, hemofiltration provides high clearances for large solutes but its effect on protein-bound solutes has been largely ignored. METHODS: Standard clinical systems were used to remove test solutes from a reservoir containing artificial plasma. Clearances of the protein-bound solutes phenol red (C(PR)) and indican (C(IN)) were compared to clearances of urea (C(UREA)) during hemofiltration and hemodiafiltration. A mathematical model was developed to predict clearances from values for plasma flow Q(p), dialysate flow Q(d), ultrafiltration rate Q(f), filter size and the extent of solute binding to albumin. RESULTS: When hemofiltration was performed with Q(p) 150 mL/min and Q(f) 17 mL/min, clearance values were C(PR) 1.0 +/- 0.1 mL/min; C(IN) 3.7 +/- 0.5 mL/min; and C(UREA) 14 +/- 1 mL/min. The clearance of the protein-bound solutes was approximately equal to the solute-free fraction multiplied by the ultrafiltration rate corrected for the effect of predilution. Addition of Q(d) 42 mL/min to provide HDF while Q(p) remained 150 mL/min resulted in proportional increases in the clearance of protein-bound solutes and urea. In contrast, the clearance of protein-bound solutes relative to urea increased when hemodiafiltration was performed using a larger filter and increasing Q(d) to 300 mL/min while Q(p) was lowered to 50 mL/min. The pattern of observed results was accurately predicted by mathematical modeling. CONCLUSION: In vitro measurements and mathematical modeling indicate that CVVH provides very limited clearance of protein-bound solutes. Continuous venous hemodiafiltration (CVVHDF) increases the clearance of protein-bound solutes relative to urea only when dialysate flow rate and filter size are increased above values now commonly employed.

Acute Kidney Injury↗
PubMed1995

Elimination of flucytosine by continuous hemofiltration.

Flucytosine is effective in the treatment of serious fungal infections. Some of the patients might have acute renal failure requiring continuous hemofiltration as renal replacement therapy. We evaluated the removal of flucytosine in a patient who received the drug for systemic Candida infection while undergoing continuous hemofiltration for acute renal failure. Arterial, venous, and ultrafiltrate sample pairs were collected to evaluate flucytosine removal. Ultrafiltrate/arterial drug concentration ratios and sieving coefficients obtained with the polysulfone membrane were higher than those obtained with the polyacrylonitrile membrane. Between 2.54 and 22.56 mg of flucytosine was removed from the patient per hour when the serum drug concentrations were 21.1-126.5 mg/l. The amount of hemofiltration flucytosine removal was related to ultrafiltration flow rate, serum drug concentration, and hemofilter type. The mean continuous arteriovenous hemofiltration flucytosine clearance for the polysulfone membrane was 77.0 +/- (SD) 15.6% of the ultrafiltrate flow rate, while the clearance for the polyacrylonitrile membrane was 51.0 +/- (SD) 5.7%. In patients with renal failure, continuous hemofiltration can remove an appreciable quantity of flucytosine when the ultrafiltrate flow rate is high. Serum drug concentration determination is necessary to devise an optimal dosage regimen for the patient.

Acute Kidney Injury↗
PubMed2004

Hemofiltration in heart failure.

In patients with severe congestive heart failure (CHF), removal of edema by hemofiltration is associated with significant clinical and hemodynamic improvement, correction of hyponatremia, restoration of urine output and diuretic responsiveness, and with a striking fall in neurohormonal activation. Through these effects, hemofiltration is able to interrupt the progression of CHF toward refractoriness, and to revert the clinical condition of CHF patients to a lower functional class. Fluid refilling from the overhydrated interstitium is the major compensatory mechanism in the prevention of hypovolemia during hemofiltration. Hemofiltration can also be beneficial in patients who have only moderate cardiac insufficiency (NYHA classes II and III) and in whom over-hydration is restricted to the pulmonary district significantly contributing to limiting patients functional capacity. In this setting, hemofiltration, differently from diuretics, is able to remove the increased lung water content and to improve clinical condition, exercise capacity and lung function.

Disease Progression↗
PubMed1993

Vancomycin and tobramycin clearance in an infant during continuous hemofiltration.

OBJECTIVE: To report a case of vancomycin and tobramycin clearance by continuous veno-venous hemofiltration in an infant. Hemofiltration clearance (ClHF) was calculated by two methods and compared for ease and reliability. METHODOLOGY: Case report of a hospitalized four-month-old infant. With method A, ClHF calculation for vancomycin and tobramycin was determined by accurate collection of ultrafiltrate in five 24-hour periods and a midpoint serum sample. With method B, ClHF calculation was determined by obtaining prefilter sample, postfilter sample, and blood flow through filter (Fick principle) over three study periods, correlating to three of five study periods in method A. RESULTS: The infant received continuous veno-venous hemofiltration. With method A, vancomycin ClHF ranged from 0.27 to 0.80 mL/min; tobramycin ClHF ranged from 0.32 to 0.91 mL/min. With method B, ClHF for vancomycin ranged from 0 to 2.08 mL/min. Tobramycin ClHF ranged from 0 to 1.6 mL/min when calculated with method B. CONCLUSIONS: Continuous veno-venous hemofiltration increased the clearance of vancomycin and tobramycin requiring dosage modifications. It appears that method A, which uses the ultrafiltration concentration compared with the serum concentration is more accurate than method B, as it averages fluctuations in ultrafiltrate flow rates. Method B compares a single pre- to postfilter drug concentration and relies on an accurate measurement of ultrafiltration flow rate. Determining ClHF based upon one point in time may overestimate ClHF when the ultrafiltration flow rate varies, as it does in the critically ill. Daily serum concentrations for vancomycin and tobramycin are recommended during continuous veno-venous hemofiltration.

Female↗
PubMed2002

Hemofiltration, adsorption, sieving and the challenge of sepsis therapy design.

Circulating inflammatory mediators spilling into the circulation from sites of active inflammation are considered the source of remote tissue injury and associated organ dysfunction in sepsis. Hemofiltration has been proposed as a therapy for sepsis based on its ability to remove circulating inflammatory mediators by sieving or by adsorption, or both. Designing devices and methods for sepsis therapy will require optimization of these two mechanisms. In the present issue of Critical Care Forum, Kellum and Dishart report the relative effects of sieving and adsorption on plasma IL-6 following cecal ligation and puncture in rats. The authors conclude that hemoadsorption is the main mechanism of removal, and discuss some possible implications for filter design but hemoadsorption is well dependant on hemofiltration (the so-called hemofiltration filter adsorption/synergistic effect). It is important to recognize the limitations of conventional systems; Kellum and Dishart have extended our knowledge of hemofiltration filter adsorption, which is quite different from conventional hemoadsorption. If sepsis is a manifestation of a nonlinear dynamic control system out of control, then filtration at modest doses with a large pore filter may succeed as well as high-volume hemofiltration with a conventional cut-off filter. In the present paper, we will explore the strengths and the weaknesses of the 'Kellum and Dishart' study and discussing their findings in the light of the current available literature.

Adsorption↗
PubMed2004

Hemofiltration in the prevention of radiocontrast agent induced nephropathy.

AIM: The aim of the study was to investigate the role of hemofiltration in preventing contrast nephropathy in patients with renal failure. METHODS: We randomized 114 renal failure patients undergoing percutaneous coronary interventions (PCI) to either peri-procedural hemofiltration or saline hydration. RESULTS: Contrast nephropathy occurred in 5% of hemofiltration-treated patients and in 50% in controls (P<0.01). In-hospital event rate as well as in-hospital and 1-year mortality rates were lower in patients treated with hemofiltration. CONCLUSION: In patients with renal failure undergoing PCI, peri-procedural hemofiltration is effective for the prevention of contrast nephropathy, and is associated with improved in-hospital and long-term outcome.

Angioplasty, Balloon, Coronary↗
PubMed1989

Clinical aspects and applications of hemofiltration.

Thirty patients were referred for intermittent hemofiltration (HF) and were followed for long-term effects. Biochemical and uremic controls were comparable to those in the preceding hemodialysis (HD) period. All patients preferred to continue HF since they suffered fewer and less serious treatment-related complications. One hundred critically ill patients who developed acute renal failure were treated with continuous arteriovenous hemofiltration (CAVH). The survival rate was 45% and adequate uremic control was achieved with CAVH alone in 89 patients. The major improvement obtained with CAVH was the possibility of giving adequate nutritional support without the risk of overhydration, even to anuric hypotensive patients. The pharmacokinetics of intravenous cefuroxime was studied during HF and CAVH. During HF removal of cefuroxime was considerably higher than during HD. During CAVH, extrarenal clearance was two thirds of the total clearance. Dosage recommendations for HF and CAVH are given. Aluminum clearance and aluminum removal after a desferrioxamine infusion test was found to be 2.5-3 times higher during HF than during ordinary HD. A combination of HD and charcoal hemoperfusion was found to be more effective than HD, but less effective than HF. During HF there was a significant decrease in intact parathyroid hormone (PTH) in serum as well as in mid-C regional PTH and C-terminal PTH. Significant amounts of intact PTH were found in the ultrafiltrate of 8 of 17 patients. Another explanation of the fall in PTH was a down-regulation of the secretion of intact PTH, since there was an increase in serum calcium during hemofiltration. Osteocalcin--i.e., bone Gla-protein--was found in the ultrafiltrate during hemofiltration in all patients and the serum levels of osteocalcin decreased significantly during hemofiltration.

Acute Kidney Injury↗
PubMed1995

Continuous arteriovenous hemofiltration does not improve survival in a canine model of septic shock.

BACKGROUND: We examined whether or not continuous arteriovenous hemofiltration (CAVH), in the absence of renal failure, would improve either hemodynamic abnormalities or survival in a canine model of septic shock. STUDY DESIGN: Escherichia coli 0111, as an intraperitoneal clot, was surgically implanted into 21 one- to two-year-old purpose-bred beagles. The dogs were randomized to no CAVH (control group, n = 7), sham CAVH (extracorporeal circulation without hemofiltration, n = 7), or true CAVH (hemofiltration with removal of 600 mL/hour of ultrafiltrate, n = 7). Hemofiltration began one hour after clot implantation and continued for six hours. All dogs received antibiotics and had serial hemodynamic and laboratory evaluations. RESULTS: During the first seven hours of the study, all dogs displayed a progressive, significant decrease in mean arterial pressure, cardiac index, left ventricular ejection fraction, and serum pH (all p < 0.05). Two of seven dogs in the control group, one of seven dogs in the sham CAVH group, and one of seven dogs in the true CAVH group survived seven days after clot implantation. True CAVH, which included fluid replacement with lactated Ringer's solution, significantly increased serum lactate and decreased serum bicarbonate levels after six hours (both p < 0.05). However, pH did not differ between the three treatment groups (p > 0.20). Continuous arteriovenous hemofiltration therapy had no significant effect on cardiovascular abnormalities or survival. CONCLUSIONS: The results of this study suggest that CAVH would be unlikely to provide benefit to patients with gram-negative septic shock, in the absence of renal failure.

Animals↗
PubMed1994

Anticoagulation with prostacyclin and heparin during continuous venovenous hemofiltration.

OBJECTIVES: To investigate anticoagulation with prostacyclin (prostaglandin I2 [PGI2]) and/or heparin during continuous venovenous hemofiltration, and the role of in vitro tests of primary hemostasis in controlling anticoagulation. DESIGN: Prospective, randomized, controlled trial. SETTING: Intensive care unit. PATIENTS: Forty-six consecutive, critically ill, mechanically ventilated patients with postoperative acute renal failure. INTERVENTIONS: Anticoagulation of the patient's blood was accomplished using heparin (6.0 +/- 0.3 IU/kg/hr for group 1), PGI2 (7.7 +/- 0.7 ng/kg/min for group 2), or both PGI2 and heparin (6.4 +/- 0.3 ng/kg/min, 5.0 +/- 0.4 IU/kg/hr, respectively, for group 3), administered into the extracorporeal line before the hemofilter during continuous venovenous hemofiltration. MEASUREMENTS AND MAIN RESULTS: After Ethics Committee approval and informed consent were obtained, tests of primary and secondary hemostasis, plasma concentrations of 6-ketoprostaglandin F1 alpha (by radioimmunoassay), and hemodynamic measurements were performed before hemofiltration and 24 hrs after hemofiltration. In groups 1 and 3, hemodynamic parameters remained stable, whereas in group 2 (the PGI2 group), there were significant reductions in systemic and pulmonary vascular resistances and mean arterial pressure. Platelet function was unchanged in group 1, and was inhibited in groups 2 and 3. Corresponding with the prolongation of in vitro bleeding time, the 6-ketoprostaglandin F1 alpha concentration was increased, indicating an effective inhibition of platelet aggregation within the hemofilter. Platelet counts remained stable in all patients. Plasma coagulation tests were stable in groups 2 and 3, and were prolonged in group 1. In all patients, no major bleeding complications were observed and there was no clinically important bleeding. Mean hemofilter duration lasted longest in group 3. Blood urea nitrogen and circulating creatinine concentrations decreased significantly in groups 2 and 3 within the study period. CONCLUSIONS: Patients receiving both PGI2 and heparin showed better hemodynamic profiles and enhanced hemofilter duration compared with the other groups and no bleeding complications were observed. Therefore, we recommend anticoagulation with PGI2 and heparin during continuous venovenous hemofiltration with close monitoring of platelet function, coagulation profile, and overall hemodynamics.

6-Ketoprostaglandin F1 alpha↗
PubMed1996

[Continuous hemofiltration. Development of an experimental model].

OBJECTIVE: Continuous hemofiltration is an extracorporeal technique used to eliminate water and solutes by convective transport through a hemofilter. The aim of this study was to develop an experimental model of arterio-venous and veno-venous continuous hemofiltration in order to gain experience before its clinical application in human neonates. MATERIALS AND METHODS: Twelve white New Zealand adult rabbits were anesthetized, tracheotomized and connected to a continuous flow neonatal ventilator. Continuous arterio-venous hemofiltration (n = 6) was performed via catheters placed in the carotid artery and jugular vein and veno-venous hemofiltration (n = 6) by a double-lumen catheter located in the inferior vena cava. Heart rate, arterial pressure, pH and blood gases, and the volume of ultra-filtrate were monitored and recorded for a three hour period. RESULTS: In both groups a high rate of ultrafiltration was achieved. The volume of ultrafiltration decreased somewhat during the second hour and remained stable thereafter. No hemodynamic changes were detected. CONCLUSIONS: The development of an experimental model for continuous arterio-venous and veno-venous hemofiltration in rabbits, facilitated the implantation of these techniques in human neonates. The model may be used to train the staff of the Neonatal Intensive Care Unit and to eliminate difficulties with vascular access and the care of extracorporeal lines.

Acute Disease↗
PubMed1998

Hemofiltration removes bradykinin generated in the priming blood in cardiopulmonary bypass during circulation.

After induction of hemofiltration for the hemic prime of a cardiopulmonary bypass, the initial drop in blood pressure disappears, and postoperative edema rarely occurs. We have suspected that bradykinin, a strong vasodilator generated through the activation of factor XII, prekallikrein, and high molecular weight kininogen was removed by ultrafiltration. We examined the changes in the activities of plasma-factor XII, prekallikrein, high molecular weight kininogen and in the levels of bradykinin in the priming blood using red cell concentrates before and after hemofiltration, and evaluated the effectiveness of hemofiltration. Ten circuits were used, and ten sets of blood samples were collected from red cell concentrates, the priming blood before hemofiltration, after hemofiltration, and the filtrate. During circulation in the circuit, factor XII, prekallikrein and high molecular weight kininogen were completely consumed and a large amount of bradykinin was generated, but it was filtered well by ultrafiltration. Factor XII, prekallikrein and high molecular weight kininogen could be activated through the dilution of red cell concentrates during the priming and contact with the circuits. Because bradykinin is the most potent vasodilator, increasing microvascular permeability and relating to several other inflammatory mediators, the removal of bradykinin generated from factor XII, prekallikrein and high molecular weight kininogen is very significant in the prevention of non-specific inflammatory reactions during and after open-heart surgery.

Bradykinin↗
PubMed1998

[Hemofiltration during severe sepsis or multiorgan failure syndrome].

Continuous renal replacement therapy (CRRT) has been used in intensive care units particularly in patients with sepsis or multiorgan failure. In comparison to intermittent haemodialysis, hemofiltration techniques offers an improved hemodynamic tolerance, related to the absence of osmotic pressure gradient. Indeed, hemofiltration is based on the physical principle of convection to remove substances from the plasma. The removal of substances that are released during sepsis, acute respiratory distress syndrome or multiorgan failure may be of particular interest. Several human studies have demonstrated that hemofiltration removes various inflammatory mediators, but the clinical significance of this removal remains questionable. If this removal occurs predominantly by convection, interest in hemofiltration will focus on high volume hemofiltration in order to obtain maximal ultrafiltrate flows. Patients with sepsis or multiorgan failure require close monitoring of most vital functions. The use of a CRRT technique emphasizes the importance of this monitoring and adds new monitoring issues relative to fluid balance, anticoagulation, hypothermia or drug removal.

Cytokines↗
PubMed1978

Assessment of hormone loss through hemofiltration.

The concentrations of testosterone, cortisone, gastrin, insulin, gastric inhibitory polypeptide (GIP), somatomedin B, parathyroid hormone (PTH), human growth hormone (HGH) and thyroid stimulating hormone (TSH) have been determined in the plasma and the ultrafiltrate of five uremic patients undergoing intermittent hemofiltration treatment. There was a considerable loss of gastrin, insulin, GIP, somatomedin B and PTH by hemofiltration treatment. The plasma concentrations, however, did not decrease except for immunoreactive-PTH (IR-PTH) which returned from elevated to normal levels. Cortisone, HGH and TSH concentrations in the ultrafiltrate were below the measureable range. A significant elimination of 11-hydroxylated androstans by hemofiltration may have a positive effect on the disturbed steroid metabolism. Results indicate that hemofiltration does not cause a hormone deficiency syndrome. On the contrary, the loss of degradation products of hormones with disturbing biological activity may be a favorable effect of the hemofiltration treatment.

Cortisone↗