Interpreting the mechanisms of continuous renal replacement therapy in sepsis: the peak concentration hypothesis.

Abstract

Severe sepsis and septic shock are the primary causes of multiple organ dysfunction syndrome (MODS), which is the most frequent cause of death in intensive care unit patients. Many water-soluble mediators with pro- and anti-inflammatory action such as TNF, IL-6, IL-8, and IL-10 play a strategic role in septic syndrome. In intensive care medicine, blocking any one mediator has not led to a measurable outcome improvement in patients with sepsis. CRRT is a continuously acting therapy, which removes in a nonselective way pro- and anti-inflammatory mediators; "the peak concentration hypothesis" is the concept of cutting peaks of soluble mediators through continuous hemofiltration. Furthermore, there is evidence of increased efficacy of high-volume hemofiltration compared to conventional CVVH, and other blood purification techniques that utilize large-pore membranes or sorbent plasmafiltration are conceptually interesting.

• Authors: Claudio Ronco, Ciro Tetta, Filippo Mariano, Mary Lou Wratten, Monica Bonello, Valeria Bordoni, Ximena Cardona, Paola Inguaggiato, Lidia Pilotto, Vince d'Intini, Rinaldo Bellomo
• Journal: Artificial organs (Artif Organs) Vol. 27 Issue 9 Pg. 792-801 (Sep 2003) ISSN: 0160-564X [Print] United States
• PMID: 12940901 (Publication Type: Journal Article, Review)

Chemical References

• Cytokines

Topics

• Acute Kidney Injury (etiology, prevention & control)
• Critical Illness
• Cytokines (metabolism, physiology)
• Humans
• Multiple Organ Failure (etiology, prevention & control)
• Renal Replacement Therapy (methods)
• Sepsis (therapy)