Early hemofiltration as immunomodulation for septic shock in acute on chronic kidney disease: a case report

Abstract

Bacterial endotoxins in sepsis induce dysregulation and excessive release of inflammatory mediators and cytokines, leading to organ dysfunction. Removing excess endotoxins and cytokines from the circulation could potentially reverse the dysregulation of the immune response. oXiris filter is capable of filtration and adsorption middle-size molecule cytokines and large molecular archives such as endotoxins.
 A man, 77 years old, weighing 70 kg, with 174 cm height and 23.17 BMI was diagnosed with septic shock with Fournier gangrene, acute on chronic kidney disease, uncontrolled blood sugar, and history of diabetes mellitus. He was put on meropenem antibiotic therapy. After necrotomies, increase in the levels of leukocytes, urea, creatinine, procalcitonin, D-dimer, NT-proBNP, and IL 6 was observed. Vasopressor dose was increased, and the patient also experienced tachycardia and fever.
 Meropenem was stopped and replaced with ceftaroline fosamil, and 24 h later hemofiltration with an oXiris filter was performed for 48 h. After hemofiltration, there was a decrease in vasopressor dose, urea, creatinine, and procalcitonin values. The patient′s hemodynamic status was stable without vasopressor, the dose of furosemide was decreased, and the urine output was increased. Then, the patient was transferred to the ward. The current patient had an upregulation of pro-inflammatory mediators as evidenced by clinical symptoms and laboratory findings. Additional treatment with extracorporeal blood purification techniques such as hemofiltration is required in these patients to facilitate the treatment of septic shock through the modulation of the immune response.
 Keywords: septic shock, dysregulation, hemofiltration, immunomodulation
 Citation: Elvia AS, Sedono R, George YWH. Early hemofiltration as immunomodulation for septic shock in acute on chronic kidney disease: a case report. Anaesth. pain intensive care 2024;28(1):182−186.DOI: 10.35975/apic.v28i1.2271
 Received: August 17, 2023; Reviewed: December 23, 2023; Accepted: December 23, 2023