Acute kidney injury in septic shock—do not under-treat!

Excerpt

Since the introduction of continuous haemofiltration into the ICU, the idea of clearing inflammatory mediators from patients with sepsis has become a paradigm in intensive care medicine. But despite the fact that modern high flux membranes with an average cut-off around 30–40 kD should be capable of eliminating significant amounts of inflammatory mediators including chemokines and cytokines by convection, theoretical considerations [1] have brought into question whether the amount of removal is of clinical significance considering the high turnover rates of the respective mediators. This is supported by clinical data: a RCT in patients with severe sepsis was unable to demonstrate changes in serum levels of cytokines in patients treated with CVVH with a filtration rate of 2 l/h [2]. Another elegant clinical study could demonstrate a significant influence on serum levels of various cytokines resulting mainly from adsorption occurring within the first hour of CVVH after a new membrane had been placed into the circuit, whereas the effect of convective elimination appeared negligible, at least at filtration rates of up to 2.6 l/h [3]. …