PMID- 9875910
OWN - NLM
STAT- MEDLINE
DCOM- 19990121
LR  - 20190706
IS  - 0090-3493 (Print)
IS  - 0090-3493 (Linking)
VI  - 26
IP  - 12
DP  - 1998 Dec
TI  - Diffusive vs. convective therapy: effects on mediators of inflammation in patient 
      with severe systemic inflammatory response syndrome.
PG  - 1995-2000
AB  - OBJECTIVE: To compare two forms of continuous renal replacement therapy, 
      continuous venovenous hemofiltration (CVVH) vs. continuous venovenous 
      hemodialysis (CVVHD), in terms of the removal of inflammatory mediators from the 
      blood of patients with systemic inflammatory response syndrome and acute renal 
      failure. DESIGN: Randomized crossover, clinical study. SETTING: University 
      teaching hospital. PATIENTS: Thirteen patients with systemic inflammatory 
      response syndrome and acute renal failure receiving continuous renal replacement 
      therapy. INTERVENTION: Patients were randomized to receive either convective 
      clearance using CVVH or diffusive clearance using CVVHD for the first 24 hrs, 
      followed by the other modality for 24 hrs. All treatments utilized AN69 
      hemofilters. CVVH was performed with an ultrafiltration rate of 2 L/hr and CVVHD 
      with a dialysis outflow rate of 2 L/hr. MEASUREMENTS AND MAIN RESULTS: Plasma and 
      ultrafiltrate concentrations of tumor necrosis factor (TNF)-alpha, interleukin 
      (IL)-6, IL-10, and sL-selectin were measured at 0, 1, 3, 6, 12, and 24 hrs by 
      radioimmunoassay. Plasma endotoxin concentrations were also measured at 0, 12, 
      and 24 hrs by chromogenic assay. CVVH was associated with a 13% decrease in 
      plasma TNF-alpha concentrations compared with a 23% increase while on CVVHD (p < 
      .05). Mean plasma concentrations of IL-6, IL-10, and sL-selectin were unchanged 
      over time and between therapies. Only minimal amounts of mediators were recovered 
      in the effluents with either therapy except for IL-6. The clearances for IL-6 
      were different between therapies, 1.9+/-0.8 (SD) mL/min for CVVHD and 3.3+/-1.5 
      mL/min for CVVH, (p< .01). Plasma endotoxin concentrations were not different 
      between therapies. CONCLUSION: CVVH resulted in a decrease in plasma TNF-alpha 
      concentrations as compared with CVVHD, while the type of transport mechanism used 
      did not influence plasma concentrations of IL-6, IL-10, soluble L-selectin, or 
      endotoxin. Differences in clearance for IL-6 between CVVH and CVVHD did not 
      translate into significant changes in circulating IL-6 concentrations.
FAU - Kellum, J A
AU  - Kellum JA
AD  - Department of Anesthesiology/Critical Care Medicine, University of Pittsburgh 
      Medical Center, PA, USA.
FAU - Johnson, J P
AU  - Johnson JP
FAU - Kramer, D
AU  - Kramer D
FAU - Palevsky, P
AU  - Palevsky P
FAU - Brady, J J
AU  - Brady JJ
FAU - Pinsky, M R
AU  - Pinsky MR
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Crit Care Med
JT  - Critical care medicine
JID - 0355501
RN  - 0 (Endotoxins)
RN  - 0 (Interleukin-6)
RN  - 0 (Tumor Necrosis Factor-alpha)
RN  - 126880-86-2 (L-Selectin)
RN  - 130068-27-8 (Interleukin-10)
SB  - IM
CIN - Crit Care Med. 1998 Dec;26(12):1940-2. PMID: 9875892
MH  - Acute Kidney Injury/complications/immunology/metabolism/*therapy
MH  - Convection
MH  - Cross-Over Studies
MH  - Diffusion
MH  - Endotoxins/blood
MH  - Hemodiafiltration/*methods
MH  - Hemofiltration/*methods
MH  - Humans
MH  - Interleukin-10/blood
MH  - Interleukin-6/blood
MH  - L-Selectin/blood
MH  - Systemic Inflammatory Response 
      Syndrome/complications/immunology/metabolism/*therapy
MH  - Time Factors
MH  - Tumor Necrosis Factor-alpha/metabolism
EDAT- 1999/01/06 00:00
MHDA- 1999/01/06 00:01
CRDT- 1999/01/06 00:00
PHST- 1999/01/06 00:00 [pubmed]
PHST- 1999/01/06 00:01 [medline]
PHST- 1999/01/06 00:00 [entrez]
AID - 10.1097/00003246-199812000-00027 [doi]
PST - ppublish
SO  - Crit Care Med. 1998 Dec;26(12):1995-2000. doi: 10.1097/00003246-199812000-00027.