Abstract
We reviewed the effectiveness of the removal of cytokines by blood purification. Continuous hemofiltration (CHF) and hemodiafiltration (CHDF) are not effective in removing cytokines from the blood because the clearance of cytokines is small, there is less removal with CHF or CHDF than with endogenous removal, and cytokines are synthesized during contact with the CHF or CHDF membranes. Since most of the clearance by CHF and CHDF is due to adherance to the membrane, it may be possible to decrease cytokines by increasing blood flow and by increasing the surface area of the filter. Membranes with large pores increase the filtration rate of cytokines, but do not decrease the plasma concentration of cytokines. CHF and CHDF also have adverse effects in that they remove anti-inflammatory cytokines as well as inflammatory cytokines. Blood purification by plasma exchange (PE) or polymyxin B-immobilized fibers (PMX) does not decrease the plasma concentration of cytokines.
It was concluded that blood purification by CHF, CHDF, PE or PMX is not effective in removing circulating cytokines. A multicenter control randomized trial is needed to see if blood purification is effective for hypercytokinemia.
