Lipid mediator adosorption with dialyser membrane in patients with septic shock

Abstract

Introduction Several studies have shown the effectiveness of non-renal indication of continuous renal replacement therapy (CRRT) or endotoxin-adosorbing fibers (direct hemoperfusion therapy with polymyxin-B immobilized fibers (PMX-DHP)) for patients with septic shock in improving unstable cardiovascular status. This nonrenal indication of CRRT might be the additional benefits that resulted in adsorbing various bioactive lipid mediators with dialyser membranes. PMX-DHP is also known to adosorb various bioactive mediators except endotoxin. In this investigation, the additional benefits of CRRT and PMX-DHP were assessed in patients with septic shock. Methods Polymethylmethacrylate (PMMA), polysulfone, polyacrylonitrile and polymyxin-B immobilized fiber (PMXBIF) were investigated after use in patients with septic shock. Various adosorbed bioactive lipid mediators, mainly arachidonylethanolamide and 2-arachidonylglycerol, in these fibers were measured with gas chromatography/mass spectrometry/selected-ion monitoring using the isotope dilution method. Results Bioactive lipid mediators, such as 2-arachidonylglycerol and arachidonylethanolamide, were adosorbed most in PMXBIF and then in PMMA, while polysulfone and polyacrylonitrile adosorbed a relatively low amount of lipid mediators. Conclusion The amount of adosorbed bioactive lipid mediators with PMXBIF and PMMA cannot be disregarded. It is necessary to take this result into consideration for selection of the dialyser membrane at the time of nonrenal indication of CRRT for patients with septic shock.