Efficacy of Series Double Connection Continuous Hemodiafiltration using Two Polymethyl Methacrylate Membrane Hemofilters for the Treatment of Hypercytokinemia

Abstract

【Objective】 Continuous hemodiafiltration (CHDF) using a hemofilter made from a membrane with cytokine adsorption properties is believed to be effective in removing cytokines during sepsis treatment. We devised a series double connection continuous hemodiafiltration (SD-CHDF) method for the treatment of hypercytokinemia and evaluated the clinical efficacy of this method. The method involves the serial connection of 2 polymethyl methacrylate membrane (PMMA) hemofilters, which increase adsorption area and result in increased cytokine removal capacity. 【Patients】 We examined 9 patients with increased serum IL-6 levels (＞900 pg/mL) who underwent SD-CHDF for hypercytokinemia at the intensive care unit of Almeida memorial Hospital from June 2010 to May 2012. We compared the clinical efficacy of SD-CHDF in our patients with that of single PMMA-CHDF (S-CHDF) in patients with a similar pathological condition. 【Methods and Results】 Serum IL-6 levels were measured before and 6, 12, and 24 h after the initiation of CHDF in both groups. Serum IL-6 levels decreased significantly at 6 and 12 h in the SD-CHDF group, whereas they decreased only at 24 h in the S-CHDF group. In addition, SD-CHDF significantly decreased blood lactate levels, whereas S-CHDF did not. 【Conclusion】 SD-CHDF using 2 PMMA hemofilters with cytokine adsorbing capacity is effective in the removal of cytokines during the treatment of hypercytokinemia. However, further investigation is necessary to confirm its efficacy in improving survival rates of septic patients.