Interpreting the mechanisms of continuous renal replacement therapy in sepsis: The peak concentration hypothesis

Claudio Ronco, Ciro Tetta, Filippo Mariano, Mary Lou Wratten, Monica Bonello, Valeria Bordoni, Ximena Cardona, Paola Inguaggiato, Lidia Pilotto, Vince D'Intini, Rinaldo Bellomo

Research output: Contribution to journalReview ArticleResearchpeer-review

204 Citations (Scopus)


Severe sepsis and septic shock are the primary causes of multiple organ dysfunction syndrome (MODS), which is the most frequent cause of death in intensive care unit patients. Many water-soluble mediators with pro- and anti-inflammatory action such as TNF, IL-6, IL-8, and IL-10 play a strategic role in septic syndrome. In intensive care medicine, blocking any one mediator has not led to a measurable outcome improvement in patients with sepsis. CRRT is a continuously acting therapy, which removes in a nonselective way pro- and anti-inflammatory mediators; "the peak concentration hypothesis" is the concept of cutting peaks of soluble mediators through continuous hemofiltration. Furthermore, there is evidence of increased efficacy of high-volume hemofiltration compared to conventional CVVH, and other blood purification techniques that utilize large-pore membranes or sorbent plasmafiltration are conceptually interesting.

Original languageEnglish
Pages (from-to)792-801
Number of pages10
JournalArtificial Organs
Issue number9
Publication statusPublished - 1 Sep 2003


  • Acute renal failure
  • Continuous renal replacement therapy
  • Homeostasis
  • Multiple organ dysfunction syndrome
  • Peak concentration
  • Sepsis

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