Enhancing Cytokine Clearances with Sustained Low- Efficiency Diafiltration (SLED-f) Using High Cut-off Dialyzer in Septic AKI Patients: A Randomized Trial
Tiranathanagul K, MD¹ , ², Tunpornchai J, MD¹ , ³, Srisawat N, MD¹ , ², Susantitaphong P, MD, PhD¹, Paditpornsilpa K, MD¹, Eiam-Ong S, MD¹
Affiliation : ¹ Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand ² Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand ³ Kasemrad Hospital Saraburi, Thailand
Background: Hypercytokinemia contributes a major role in the pathogenesis and is associated with the high mortality in sepsis-
related acute kidney injury (AKI). Reductions of these cytokines have been reported to improve clinical outcomes. Online sustained
low-efficiency diafiltration (SLED-f) using traditional high-flux (HF) dialyzer could remove some cytokines. Interestingly, the
potential of enhancing cytokine removal by using newly designed high cut-off (HCO) dialyzer that could theoretically remove
larger molecular weight solutes has never been studied in SLED-f before.
Materials and Methods: The present randomized controlled trial was conducted in sepsis-related AKI patients to compare the efficacy of cytokine removal including interleukin (IL)-6, IL-8, IL-10, and tumor necrotic factor (TNF)-α by six-hour SLED-f between using HCO dialyzer (HCO-SLED-f, n = 8) and HF dialyzer (HF-SLED-f, n = 8).
Results: HCO-SLED-f provided significantly higher clearances of TNF-α, IL-6, and IL-10 than HF-SLED-f. HCO-SLED-f demonstrated significant IL-8 and TNF-α reductions, (p=0.012 for both) after treatment whereas HF-SLED-f could only yield significant TNF-α reduction (p=0.018). The degree of all cytokine reductions did not show significant differences between both treatment groups. There were significantly higher total albumin losses in effluent fluid in HCO-SLED-f group than HF-SLED-f group, (p<0.001). The percentage of plasma albumin reduction was not different between both treatment groups. There were no significant differences in intra-dialytic blood pressure parameters during both treatments.
Conclusion: In sepsis-related AKI, HCO-SLED-f could be safely applied and could enhance cytokine clearances as well as reduce more types of cytokines when compared with HF-SLED-f, although the degree of reduction did not show significant difference. The higher degree of albumin loss should be considered when using HCO-SLED-f. Trial registration : ClinicalTrials.gov, NCT03014232
Keywords : Sustained low-efficiency diafiltration (SLED-f), High cut-off dialyzer, Cytokines
