Abstract
BACKGROUND: Haemodynamic instability is common in septic patients with acute renal failure. Continuous veno-venous haemodiafiltration (CVVHD) is therefore used as an alternative to conventional haemodialysis. Haemodialysis is associated with an activation of the immune system. The aim of the present study was to test the hypothesis that initiation of CVVHD influences the immune system with release of proinflammatory cytokines followed by a decrease in granulocyte activation, as assessed by the expression of adhesion molecules. RESULTS: Fifteen patients were included. Mean Acute Physiology and Chronic Health Evaluation-2 score before CVVHD was 19 (range 8-27). Mean duration of CVVHD treatment was 9 days (1-21 days). Tumour necrosis factor-alpha and interleukin-8 were detectable in plasma in all patients, whereas interleukin-10 was detectable only in a few patients. Proinflammatory and anti-inflammatory cytokines were detected in the ultrafiltrate. Large intraindividual and interindividual variations were demonstrated for all of the immunological parameters studied. CONCLUSION: The hypothesis that CVVHD induces the release of proinflammatory cytokines followed by a decrease in granulocyte activation was not confirmed in the present study. The heterogeneous group of patients studied, with different underlying diseases and various durations of illness before the start of CVVHD, might have contributed to the difficulty in demonstrating the proposed immunological effect of CVVHD.
Highlights
Acute renal failure as part of the multiorgan dysfunction syndrome (MODS) is a severe complication in critically ill patients
The above mentioned effects of haemodialysis are largely due to the use of cuprophane membranes
Over a period of 10 months we studied 15 consecutive critically ill patients with acute renal failure treated with Continuous veno-venous haemodiafiltration (CVVHD)
Summary
Acute renal failure as part of the multiorgan dysfunction syndrome (MODS) is a severe complication in critically ill patients. Haemodynamic instability is common in these patients and is exacerbated by haemodialysis. The above mentioned effects of haemodialysis are largely due to the use of cuprophane membranes. With the use of more biocompatible membranes, this pronounced activation of the immune system is not observed. Haemodialysis is used in (acute and chronic) renal failure for approximately 4 h three to four times a week. Haemodynamic instability is common in septic patients with acute renal failure. Haemodialysis is associated with an activation of the immune system. The aim of the present study was to test the hypothesis that initiation of CVVHD influences the immune system with release of proinflammatory cytokines followed by a decrease in granulocyte activation, as assessed by the expression of adhesion molecules
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