The aim of this study was to test the hypothesis that continuous venovenous hemofiltration (CVVH) increases HLA-DR expression on monocytes and T lymphocytes in critically ill patients. 24 septic (SP) and 10 non-septic (NSP) medical ICU patients with acute renal failure were studied prospectively. The ultrafiltration rate was 20–30 ml.kg-1.h-1. The total and differential white cell counts were measured and CD3+ lymphocyte count, HLA-DR expression on CD14+ monocytes and CD3+ lymphocytes were analysed by two-colour flow cytometry before, 4 and 24 h after CVVH initiation, respectively. CVVH did not influence leukocyte, granulocyte, total lymphocyte and CD3+ lymphocyte counts in both groups of patients. The percentage of HLA-DR+/CD14+ monocytes in SP revealed no changes, whereas it decreased after 4 h of CVVH in NSP (p<0.05). The percentage of HLA-DR+/CD3+ lymphocytes in SP decreased after 24 h (p< 0.05), whereas it remained unchanged in NSP. We conclude that CVVH initiation is not associated with the increase of HLA-DR expression on CD14+ monocytes and T lymphocytes in critically ill patients with acute renal failure.
BellomoR., RoncoC.Continuous renal replacement therapy in the intensive care unit.Intens Care Med1999; 25: 781–9.
2.
BellomoR., TippingP., BoyceN.Continuous veno-venous hemofiltration with dialysis removes cytokines from the circulation of septic patients.Crit Care Med1993; 21: 522–6.
3.
Van DeurenM., van der MeerJ.W.M.Hemofiltration in septic patients is not able to alter the plasma concentrations of cytokines therapeutically.Intens Care Med2000; 26: 1176–8.
4.
De VrieseA.S., ColardynF.A., PhilippeJ.J., VanholderR.C., De SutterJ.H., LameireN.H.Cytokine removal during continuous hemofiltration in septic patients.J Am Soc Nephrol1999; 10: 846–53.
5.
KellumJ.A., JohnsonJ.P., KramerD., PalevskyP., BradyJ.J., PinskyM.R.Diffusive vs. convective therapy: Effects on mediators of inflammation in patient with severe systemic inflammatory response syndrome.Crit Care Med1998; 26: 1995–2000.
6.
SalmonJ., CardiganR., MackieI.Continuous venovenous haemofiltration using polyacrylonitrile filters does not activate contact system and intrinsic coagulation pathways.Intens Care Med1997; 23: 38–43.
7.
ToftP., KehlerD., BrandslundI., TonnsenE.The immunological effects of continuous veno-venous haemodiafiltration in critically ill patients.Crit Care1999; 3: 159–65.
8.
LonnemannG., BechsteinM., LinnenweberS., BurgM., KochK.M.Tumor necrosis factor-α during continuous high-flux hemodialysis in sepsis with acute renal failure.Kidney Int1999; 72(Suppl): S84–7.
9.
YekebasE.F., EisenbergerC.F., OhnesorgeH.Attenuation of sepsis-related immunoparalysis by continuous veno-venous hemofiltration in experimental porcine pancreatitis.Crit Care Med2001; 29: 1423–30.
10.
Members of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee.American College of Chest Physicians/Society of Critical Care Medicine consensus conference. Definition for sepsis and organ failure and guidelines for the way of innovative therapies in sepsis.Crit Care Med1992; 20: 864–74.
11.
MorenoR., VincentJ.L., MatosR.The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study. Working group on sepsis related problems of the ESICM.Intens Care Med1999; 25: 686–96.
12.
GrootemanM.P., NubéM.J., van LimbeekJ., SchoorlM., van HouteA.J.Lymphocyte subsets in dialyser eluates: A new parameter of bioincompatibility?Nephrol Dial Transplant1996; 11: 1073–8.
13.
VolkH.D., ReinkeP., DockeW.D.Immunostimulation with cytokines in patients with “immunoparalysis”. In: MarshallJ.C., CohenJ., eds. Immune response in the critically ill.Springer, Berlin, Heidelberg, New York, 1999: pp. 393–404.
14.
BoneR.C.Immunological dissonance: A continuing evolution in our understanding of the systemic inflammatory response syndrome (SIRS) and the multiple organ dysfunction syndrome (MODS).Ann Intern Med1996; 125: 680–7.
15.
AdrieC., PinskyM.R.The inflammatory balance in human sepsis.Intens Care Med2000; 26: 364–75.
16.
DöckeW.D., RandowF., SyrbeU.Monocyte deactivation in septic patients: Restoration by INF-γ treatment.Nat Med1997; 3: 678–81.
17.
KoxW.J., BoneR.C., KrauschD.Interferon gamma-1b in the treatment of compensatory anti-inflammatory response syndrome.Arch Intern Med1997; 157: 389–93.
18.
SchillerB., Ziegler-HeitbrockH.W.L., MeyerN., SchmidtB., BlumensteinM.Monocyte phenotype and interleukin-1 production in patients undergoing hemodialysis.Nephron1991; 59: 573–9.
19.
BeekhuizenH., BloklandI., Corsel-van TilburgA.J., KoningF., van FurthR.CD14 contributes to the adherence of human monocytes to cytokine-stimulated endothelial cells.J Immunol1991; 147: 3761–7.
20.
AllenM.L., PetersM.J., GoldmanA.Early postoperative monocyte deactivation predicts systemic inflammation and prolonged stay in pediatric cardiac intensive care.Crit Care Med2002; 30: 1140–5.
21.
DitschowskiM., KreuzfelderE., RebmannV.HLA-DR expression and soluble HLA-DR levels in septic patients after trauma.Ann Surg1999; 229: 246–54.
22.
RabbH., AgostiS.J., PollardS., BittleP.A., RamirezG.Activated and regulatory T lymphocyte populations in chronic hemodialysis patients.Am J Kidney Dis1994; 24: 443–52.
23.
DepischR., GohlH., SmebyL.Microdomain structure of polymeric surfaces-potential for improving blood treatment procedures.Nephrol Dial Transplant1998; 13: 1362–4.
24.
SchindlerR., LonnemannG., ShaldonS., KochK.M., DinarelloC.A.Transcription, not synthesis, of interleukin-1 and tumor necrosis factor by complement.Kidney Int1990; 37: 85–93.
25.
MarchantA., TielemansC., HussonC.Cuprophane haemodialysis induces upregulation of LPS receptor (CD14) on monocytes: Role of complement activation.Nephrol Dial Transplant1996; 11: 657–62.
26.
VienkenJ., BaumeisterU.Improved biocompatibility of dialyzers by reduces membrane surface area.Artif Organs1987; 11: 272–3.
27.
GrootendorstA.F., van BommelE.F.H., van der HovenB., van LeengoedLAMG, van OstaA.L.M.High volume hemofiltration improves hemodynamics of endotoxin-induced shock in the pig.J Crit Care1992; 7: 67–75.
