Nephrol Dial Transplant (2003) 18: 2570-2576
© 2003 European Renal Association-European Dialysis and Transplant Association
Original Article
High permeability haemofiltration improves peripheral blood mononuclear cell proliferation in septic patients with acute renal failure
1Department of Nephrology, 2Department of Anesthesiology and 3Department of Surgery, Charité, Humboldt University of Berlin, Berlin, Germany
Correspondence and offprint requests to: Dr Stanislao Morgera, Universitätsklinikum Charité der Humboldt Universität zu Berlin, Medizinische Klinik mit Schwerpunkt Nephrologie am CCM, Schumannstrasse 20–21, D-10098 Berlin, Germany. Email: stanislao.morgera{at}charite.de
Background. Continuous veno-venous haemofiltration (HF) with high permeability (HP) haemofilters is a novel approach in the adjuvant therapy of septic patients. HP haemofilters are characterized by an increased pore size which facilitates the filtration of inflammatory mediators. The present study examines whether HP-HF has an impact on peripheral blood mononuclear cell (PBMC) proliferation and whether ultrafiltrate can alter PBMC function in isolates from healthy volunteers.
Methods. Twenty-eight septic patients with acute renal failure were randomly allocated to either HP-HF or conventional HF (C-HF). HP-HF was performed with a newly developed high-flux polyamide membrane (P2SH) with a nominal cut-off point of 60 kDa. For C-HF, a high-flux polyamide haemofilter (Polyflux 11S; cut-off, 30 kDa) was used.
Results. Septic patients demonstrated a significantly reduced proliferation of anti-CD3-stimulated PBMCs compared to healthy controls (P = 0.016). Initiating HF led to a restoration of the PBMC proliferation in HP-HF but not in C-HF. Exposing PBMCs isolated from healthy donors to ultrafiltrates from patients with sepsis demonstrated a significant suppressive effect of HP ultrafiltrates on the anti-CD3-stimulated PBMC proliferation (P = 0.011). Ultrafiltrate from patients with sepsis who received C-HF had no impact on PBMC proliferation.
Conclusion. HP-HF restores PBMC proliferation in septic patients probably by eliminating immunomodulatory mediators. HP-HF may represent a new renal replacement therapy able to modulate PBMC function in sepsis.
Keywords: acute renal failure; high permeability haemofiltration; immunomodulatory mediators; PBMC proliferation; sepsis
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