Therapeutic Apliei e.sis 6(3).234-240, Blackwcll Publishing, Inc. © 2002 International Society for Apheresis Continuous Hemodiafiltration with Polymyxin-B Immobilized Fiber Is Effective in Patients with Sepsis Syndrome and Acute Renal Failure Hiromichi Suzuki, Hironori Nemoto, Hidetomo Nakamoto, Hirokazu Okada, Soichi Sugahara, Yoshihiko Kanno, and Kenshi Moriwaki Department of Nephrology and Kidney Disease Center, Saitama Medical College, Saitama, Japan Abstract: The aim of this study was first, to evaluate the effects of continuous hemodiafiltration (CHDF) alone or combined with CHDF and polymyxin-B immobilized fiber (PMX) on survival rates of patients with sepsis and acute renal failure, and second, to evaluate the changes in plasma levels of inflammatory cytokines before and after treatment with CHDF and PMX and CHDF alone in these patients. Forty-eight patients with septic shock and acute renal failure were enrolled in this study. The survival rate of all patients at 28 days was 25% for those with CHDF and 75% for those with PMX and CHDF treatment. Com bination treatment produced a significant reduction of plasma levels of endotoxin and interleukin-6 compared to the basal values and to the treatment with CHDF alone. From these data, it is suggested that the combined therapy with PMX and CHDF is effective in improvement of sur vival rate of patients with septic shock and acute renal failure. Key Words: Acute renal failure-APACHE II Cytokines-Continuous hemodiafiltration-Polymyxin B-Septic syndrome. In critical care practice, it is important to treat the patients with severe sepsis or septic shock for im provement of survival rate (1,2). However despite the vigorous advances in supportive therapy, such as newly developed antibiotics, innovation of respira tory machines, and so forth, there are no remarkable increases in survival rates of these patients around the world (3). The few agents that have reached large-scale clinical study have been disappointing and as yet no treatment has shown an unequivocal survival benefit (4). Continuous venovenous hemo filtration (CHF) has been used successfully to con trol renal failure in septic patients even when they are in shock (5-8). The primary advantage of CHF is to provide smooth and continuous control of the vol ume status while avoiding cardiovascular instability (9). A potential benefit of CHF is to remove a num ber of proinflammatory mediators that may be in volved in the development of multiple organ failure Received December 2001; revised January 2002. Address correspondence and reprint requests to Dr. Hiromichi Suzuki, Department of Nephrology and Kidney Disease Center, Saitama Medical College, Moroyama-machi, Iruma-gun, Saitama Prefecture, Japan. E-mail: iromichi@saitama-med.ac.jp (MOF) (10,ll). However, data from experimental and clinical studies have been inconsistent and some times contradictory (12). During sepsis, release of various endotoxins from microorganisms activates immune cascade systems including release of anti- and proinflammatory cyto kines. As described above, these cytokines might be removed with CHF; however, it remains uncertain whether endotoxins are removed effectively with CHF (13). Recently, immobilized polymyxin-B fi bers (PMXs), which were developed to remove en dotoxin selectively, have been available clinically in Japan (14,15). This newly developed technique pro vides some successful results (16,17). These 2 techniques listed above seem to be effec tive for treatment of critically ill patients with sepsis and acute renal failure (ARF). However, whether and to what extent combined PMX treatment and CHF provides interaction effects for the prognosis of these patients remains unexplored. In the present study, we undertook to compare the efficacy of CHF and its combination with PMX for prognosis of critically ill patients with sepsis and ARF in a prospective randomized open trial. To do 234