[The effect of continuous high-volume hemofiltration therapy on TNF-alpha of pancreatitis patients complicated with acute renal function failure].

ABSTRACT

AIM: To explore the role of continuous high-volume renal replacement therapy(HV-CRRT) in serum TNF-alpha removal. METHODS: 13 panceatitis patients complicated with acute renal failure were treated by continuous venovenous hemofiltration (CVVH), and they were divided into two groups according to the substitution rate during CVVH. The substitution rate of group I (8 cases) was 2 L/h, the that of group II(5 cases) was 4 L/h. 1ml blood samples were taken from the post-filter at 0,1,2,3,6 and 24 h after CRRT, respectively. The TNF-alpha level produced from endotoxin-induced periphral blood mononuclear cells (PBMCs) was detected by ELISA. Ultrafiltrate samples were co-incubated with donor's whole blood containing ET so as to detect suppression activity of ultrafiltrate. RESULTS: Production of TNF-alpha by ET-induced PBMCs was significantly suppressed in group I and II. During CVVH treatment, suppressed ET-induced TNF-alpha production increased variously in the first 3 h, and then decreased gradually. In contrast, the increased levels of ET-induced TNF-alpha production in group II were higher than that in group I, and maintained a higher level until 24 h after CVVH therapy. The ultrafiltrate from group I had no suppressing activity, but the ultrafiltrate from group II suppressed ET-induced TNF-alpha production, the suppression rate was (15+/-6)%. CONCLUSION: HV-CRRT is more effective than standard CRRT in removal of inflammatory mediators. The mediators are removed mainly by filter membrane adsorption, and maybe partly by convection. Therefore, HV-CRRT with large-pore filter membranes is an effective way in removal of inflammatory mediators.