MEDIATOR REMOVAL WITH CRRT - COMPLEMENT AND CYTOKINES

The evidence from animal sepsis models that hemofiltration may amelior ate the hemodynamic changes that occur in septic shock has led to spec ulation that continuous renal replacement therapy may have nonrenal be nefits in septic patients, Much of the subsequent work has been done t o elucidate the mechanisms of this benefit, in particular the role of removal of inflammatory mediators including cytokines and complement. The significance of extracorporeal removal of such products is depende nt on the relative importance of endogenous production and clearance i n the setting of sepsis and multiple organ failure and on the method o f blood purification, This article reviews the evidence thus far, cons isting of in vitro, animal, and human studies; a range of mediators (T NF alpha, IL-1 beta, IL-6, IL-8, complement factors G(3)a, C(5)a, and D); various membranes (polyacrylonitrile, polysulfone, and polyamide); and clearance by diffusion, convection, and adsorption, The most cons istent results suggest that the plasma levels of some mediators are lo wered by a combination of membrane adsorption and convection, the clin ical significance of which is still uncertain, The review shows the ne ed for further work to unravel the role of CRRT in treating septic pat ients. (C) 1997 by the National Kidney Foundation, Inc.