Pre-dilution continuous hemofiltration in septic AKI

Abstract

Large molecular weight substances such as cytokines are related to the pathogenesis of sepsis. Therefore, continuous hemofiltration (CHF) is appropriate for treatment of septic AKI because CHF is superior to other modalities of continuous blood purification for clearance of large molecular weight substances. Modalities of CHF include pre-dilution and post-dilution methods. Pre-dilution CHF has the demerit of a decrease in the clearance of small or middle molecular weight substances, and post-dilution CHF has the demerit of shortening of the filter life-time and inappropriate biocompatibility. Data obtained from a clinical setting and an in vivo experiment using test solutions showed that pre-dilution CHF had a stronger inhibitory effect on excess activation of leukocytes and platelets than did post-dilution CHF. On the other hand, post-dilution CHF was superior for clearance of small or middle molecular weight substances, but pre-dilution CHF and post-dilution CHF showed no difference in clearance of large molecular weight substances, which are related to sepsis. Pre-dilution CHF is recommended for patients with septic AKI because of its superiority of biocompatibility and equality of clearance of large molecular weight substances. Fortunately, a new machine that can perform pre-dilution CHF has been developed and has recently become available in Japan, we should establish implementation of CHF depending on clinical features.