Hemofiltration removes bradykinin generated in the priming blood in cardiopulmonary bypass during circulation

After induction of hemofiltration for the hemic prime of a cardiopulmonary bypass, the initial drop in blood pressure disappears, and postoperative edema rarely occurs. We have suspected that bradykinin, a strong vasodilator generated through the activation of factor XII, prekallikrein, and high molecular weight kininogen was removed by ultrafiltration. We examined the changes in the activities of plasma-factor XII, prekallikrein, high molecular weight kininogen and in the levels of bradykinin in the priming blood using red cell concentrates before and after hemofiltration, and evaluated the effectiveness of hemofiltration. Ten circuits were used, and ten sets of blood samples were collected from red cell concentrates, the priming blood before hemofiltration, after hemofiltration, and the filtrate. During circulation in the circuit, factor XII, prekallikrein and high molecular weight kininogen were completely consumed and a large amount of bradykinin was generated, but it was filtered well by ultrafiltration. Factor XII, prekallikrein and high molecular weight kininogen could be activated through the dilution of red cell concentrates during the priming and contact with the circuits. Because bradykinin is the most potent vasodilator, increasing microvascular permeability and relating to several other inflammatory mediators, the removal of bradykinin generated from factor XII, prekallikrein and high molecular weight kininogen is very significant in the prevention of non-specific inflammatory reactions during and after open-heart surgery.