Hemofiltration for cytokine-driven illnesses: the mediator delivery hypothesis

Area of Science:

• Critical Care Medicine
• Renal Physiology
• Immunology

Background:

• Hemofiltration is an emerging adjunctive therapy for systemic inflammation, including sepsis.
• It is often used to support renal function and non-specifically clear pro-inflammatory mediators.
• Current hypotheses focus on cytokine removal at the semi-permeable membrane.

Purpose of the Study:

• To propose an alternative hypothesis for hemofiltration's therapeutic effect in systemic inflammation.
• To investigate the role of lymphatic system re-invigoration in hemofiltration therapy.

Main Methods:

• The study reviews existing literature and proposes a new theoretical model.
• It analyzes the physiological effects of large-volume crystalloid replacement during hemofiltration.
• The proposed mechanism involves mobilization of inflammatory mediators into the lymphatic system.

Main Results:

• Hemofiltration involves significant daily infusion of crystalloid replacement solutions (48-72 L).
• This fluid administration can lead to redistribution into the interstitium and lymph.
• This redistribution mobilizes inflammatory mediators, proteins, cellular debris, and free DNA.

Conclusions:

• Hemofiltration may exert its beneficial effects by restoring lymphatic flow and function.
• Mobilized substances are cleared via multiple organs and the hemofilter itself.
• This alternative hypothesis offers a new perspective on hemofiltration in critical illness.