![]() ![]() Case reports showed reduction in serum k-free light chains and myoglobin levels with the EMiC2 filter, but actual removal by the filter was not investigated. The EMiC2 filter (Fresenius, Bad Homburg, Germany) is a polysulfone (PS)-based membrane with a cut-off of 45 kDa. Besides, the concomitant loss of albumin, proteins, micronutrients, and antibiotics is a concern. HCO haemofiltration with a cut-off up to 60 kDa has been shown to achieve higher cytokine clearance than conventional membranes (15–30 kDa), but the effects on clinical outcomes such as haemodynamic improvement, severity scores, and survival are inconclusive. The proposed techniques include high-volume haemofiltration (HVHF), use of high cut-off (HCO) membrane and adsorption techniques, or plasmapheresis. Finally, a ‘cellular theory’ refers to removing leucocytes directly or through immune cell reprogramming. The ‘cytotoxic threshold immune modulation theory’ relates to the removal of cytokines from the cytokine-concentrated interstitium and tissues into the circulation. The ‘cytokinetic theory’ proposes that cytokine removal creates a decreased cytokine gradient between tissues and the bloodstream and promotes leukocyte chemotaxis towards the infected tissues. The ‘peak concentration hypothesis’ proposes that during BPT excessive pro- or anti-inflammatory mediators are removed and plasma concentrations decrease to levels below a toxic threshold. With regards to the potential benefit of BPT, there are several hypotheses. However, KRT may offer the opportunity to provide extracorporeal blood purification therapy (BPT). Ĭritically ill patients with sepsis-associated acute kidney injury (AKI) requiring kidney replacement therapy (KRT) are at particularly increased risk of death. ![]() Sepsis is a life-threatening condition in which a dysregulated release of pro- and anti-inflammatory cytokines can lead to multiple organ failure and increased mortality. Trial registration: NCT03231748, registered on 27th July 2017. This suggests that changes in plasma cytokine concentrations may not be solely influenced by extracorporeal removal. ConclusionĮMiC2-CVVHD achieved modest removal of most cytokines and demonstrated small to no adsorptive capacity despite a decline in plasma cytokine concentrations. The percentage of cytokine removal was low for most cytokines throughout the 48-h period. The effluent and adsorptive clearance rates remained steady over time. Negative or minimal adsorption was observed. ![]() The effluent clearance rates were variable and ranged from negligible values for IL-2, IFN-γ, IL-1α, IL-1β, and EGF, to 19.0 ml/min for TNF-α. All cytokines except EGF concentrations declined over 48 h ( p < 0.001). Twelve patients were included in the final analysis. Outcomes were the effluent and adsorptive clearance rates, mass balances, and changes in serial serum concentrations. We measured concentrations of 12 cytokines in plasma at baseline (T0) and pre- and post-dialyzer at 1, 6, 24, and 48 h after CVVHD initiation and in the effluent fluid at corresponding time points. This was a prospective observational study conducted in critically ill patients with sepsis and acute kidney injury requiring kidney replacement therapy. This study aimed to explore the effects of continuous veno-venous haemodialysis (CVVHD) using the EMiC2 filter on cytokine clearance. Little is known regarding its efficacy in eliminating medium-sized cytokines in sepsis. The EMiC2 membrane is a medium cut-off haemofilter (45 kiloDalton). ![]()
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