High-volume hemofiltration.

Abstract

The use of continuous hemofiltration has increased dramatically since its first description in 1977. It is now the dominant form of renal replacement therapy in Australia and is fast reaching a similar status in many European countries. Its growing use and the frequent observation of its beneficial effects in septic patients has directed the attention of researchers toward its application in the field of blood purification for sepsis. In this context, experimental studies have suggested that increasing the volume of ultrafiltrate produced may increase the beneficial effects of continuous hemofiltration. This so-called high-volume hemofiltration (HVHF) has now been demonstrated to have striking beneficial effects on hemodynamics in porcine septic shock. It has also been shown to attenuate gastrointestinal mucosal reperfusion injury in a model of gut ischemia. Furthermore, the infusion of ultrafiltrate obtained during HVHF into healthy pigs induces profound hypotension and myocardial depression, suggesting that vasodilatory and myocardial depressant substances may be removed during the procedure. Such animal experiments have led clinicians to conduct their first interventions with HVHF in humans with the multi-organ dysfunction syndrome and septic shock. The initial results are promising. They open up a new area for the investigation of HVHF as an adjuvant therapy in the management of severe sepsis, septic shock, and the multi-organ dysfunction syndrome.