Extracorporeal therapies in non-renal disease: Treatment of sepsis and the peak concentration hypothesis

Claudio Ronco, Monica Bonello, Valeria Bordoni, Zaccaria Ricci, Vincenzo D'Intini, Rinaldo Bellomo, Nathan W. Levin

Research output: Contribution to journalReview ArticleResearchpeer-review

86 Citations (Scopus)

Abstract

In the setting of intensive care, patients with acute renal failure often present a clinical picture of the systemic inflammatory response syndrome (SIRS). SIRS can be caused by bacterial stimuli or by non-microbiological stimuli that induce a significant inflammatory response. When this response is exaggerated, the patient experiences multiple organ system failure and a condition of sepsis also defined as a systemic malignant inflammation. This is mostly characterized by an invasion of cytokines and other pro-inflammatory mediators into the systemic circulation where major biological effects take place, including vasopermeabilization, hypotension and shock. At the same time, the monocyte of the septic patient seems to be hyporesponsive to inflammatory stimuli to a certain extent. In this condition, the patient faces a situation of hyperinflammation but at the same time of immunodepression expressing a clinical entity defined as counter anti-inflammatory response syndrome. The general picture of the clinical disorder is therefore better characterized by an immunodysregulation than by a simple pro- or anti-inflammatory disorder. Due to the short half-life of cytokines and other mediators spilled over into the circulation, it is extremely difficult to approach the problem at the right moment with the right pharmacological agent. For these reasons, the peak concentration hypothesis suggests that continuous renal replacement therapies, due to their continuity and unspecific capacity of removal, might be beneficial in cutting the peaks of the concentrations of both pro- and anti-inflammatory mediators, restoring a situation of immunohomeostasis. Thus the patient may benefit from a lesser degree of immunodysregulation and he/she may restore a close-to-normal capacity of response to exogenous stimuli.

Original languageEnglish
Pages (from-to)164-174
Number of pages11
JournalBlood Purification
Volume22
Issue number1
DOIs
Publication statusPublished - 9 Feb 2004
Externally publishedYes

Keywords

  • Continuous renal replacement therapy
  • Counter anti-inflammatory response
  • Immunodysregulation
  • Peack concentration hypothesis
  • Sepsis
  • Systemic inflammatory syndrome

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