การศึกษาการเปรียบเทียบประสิทธิภาพการขจัดสารไซโตคายน์อินเตอร์ลิวคิน 6 ด้วยการฟอกเลือดด้วยตัวกรองที่มีรูกรองขนาดใหญ่พิเศษเปรียบเทียบกับการฟอกด้วยตัวกรองที่มีรูขนาดใหญ่ปกติในเครื่องฟอกไดอะฟิลเตรชั่นประสิทธิผลต่ำต่อเนื่องในผู้ป่วยติดเชื้อในกระแสโลหิตที่มีภาวะไตวายฉับพลัน / จีราลักษณ์ ตันฑ์พรชัย = The comparison of the efficiency of IL-6 removal between sustained low efficiency diafiltration with high cut-off dialyzer and high-flux dialyzer in septic acute kidney injury patients / Jeeraluk Tunpornchai
Background: Hypercytokinemia plays a central role in the pathogenesis and is related to the high mortality in sepsis related acute kidney injury (S-AKI). Sustained low efficiency diafiltration (SLED-f) using traditional high-flux (HF) dialyzer has been introduced to enhanced removal of small molecular weight (MW) cytokines. Interestingly, newly designed high cut-off (HCO) dialyzer that could theoretically remove large MW solute has never been studied in SLED-f therapy before. Methods: This prospective randomized trial was conducted in fifteen S-AKI patients to compare the efficacy of IL-6 removal between traditional HF dialyzer (n=7) and HCO dialyzer (n=8) in SLED-f technique. Results: The HCO-SLED-f treatment group was older [85 years (65.0-88.0) vs. 70 years (46.5-75.3) p=0.042] and had greater the numbers of organ failure, compare with the HF-SLED-f treatment group [3 organs (2-4) vs. 4 organs (3-5) p=0.042]. Both techniques provided similarly the plasma IL-6 clearance and the percentage of IL-6 reduction. There were significantly higher albumin losses in effluent fluid in HCO-SLED-f group than HF-SLED-f group. The total albumin losses were 4.72 gram in six hours duration of a HCO-SLED-f session. However, the percentage of plasma albumin reduction was not different between both treatment groups. Result as table. The incidence of intradialytic hypotension was 50% in HCO-SLED-f group, 42.3% in HF-SLED-f, similar between both groups. Conclusion: The HCO-SLED-f technique had trended greater the plasma IL-6 clearance than HF-SLED-f. There were albumin losses 4.72 grams in 6 hours of one HCO-SLED-f session. Therefore, this modality trends to effectiveness and safety for cytokine elimination capacity in septic related AKI. However, our study too small, we suggest larger trial for confirmation.
