Hemofiltration in sepsis and septic shock: Where do we stand?

Abstract

Since continuous hemofiltration was first described by Peter Kramer as a new form of renal replacement therapy, it has undergone many changes, making it a widely accepted treatment modality for acute renal failure in critically ill patients. Concomitantly, new insights into the pathogenesis of severe sepsis and septic shock have led to a recent form of immunomodulating therapy for septic shock. A number of clinical trials investigating the effects of anti-endotoxin or anti-cytokine interventions did not consistently show an improvement in survival in patients with sepsis or septic schock. Another possibility of immunotherapy is the removal of various pro-inflammatory substances including endotoxin, cytokines, oxygen free radicals, and arachidonic acid metabolites by hemofiltration. In animal models of acute septic shock, hemofiltration has shown beneficial hemodynamic effects and even an increased short term survival. In clinical studies, although not prospective and randomized, continuous hemofiltration sometimes showed a increased patient survival rate, which was possibly due to the removal of pro-inflammatory substances. Therefore, continuous hemofiltration seems promising as an adjunctive treatment modality in severe sepsis and septic shock. However, more experimental and clinical research should be performed in order to establish the optimal hemofiltration modalities in terms of membrane, ultrafiltration rate, buffer solution, and timing of the intervention.