Background & Reviews

Extracorporeal renal replacement therapies in the treatment of sepsis: where are we?

Forni LG, Ricci Z, Ronco C.
Semin Nephrol. 2015 Jan;35(1):55-63.

This review outlines the use of extracorporeal therapies in the treatment of sepsis and septic AKI...

This review outlines the use of extracorporeal therapies in the treatment of sepsis and septic AKI, considering the classic aspects of extracorporeal renal replacement therapy including indications, timing, and delivered dose but also discussing the various techniques that are currently used to achieve immune homeostasis. The authors further discuss the evidence accumulated to date and suggest possibilities for the future treatment of this entity of patients. In this context, the CytoSorb therapy is mentioned as one of the most promising approaches, due to its improved biocompatibility and therefore the opportunity for whole blood perfusion, its efficiency in removing multiple inflammatory mediators shown in animals studies as well as in case reports and due to its beneficial effects on chemokine gradients, which may restore chemokine gradients towards infected tissue and away from healthy organs through leukocyte trafficking control.

Blood Purification and Mortality in Sepsis: A Meta-Analysis of Randomized Trials

Zhou F, Peng Z, Murugan R, Kellum JA
Crit Care Med. 2013 Sep;41(9):2209-20.

This review gives a good overview on the effects of blood purification therapies at the...

This review gives a good overview on the effects of blood purification therapies at the immunologic and cellular level. It is discussed how therapies like high-volume hemofiltration, hemoadsorption, coupled plasma filtration adsorption and high-cut off membranes have been improved in the meantime and adapted to the “setting” of sepsis.

Newly Designed CRRT Membranes for Sepsis and SIRS-A Pragmatic Approach for Bedside Intensivists Summarizing the More Recent Advances: A Systematic Structured Review.

Honore PM, Jacobs R, Joannes-Boyau O, De Regt J, De Waele E, van Gorp V, Boer W, Verfaillie L, Spapen HD.
ASAIO J. 2013 Mar;59(2):99-106

Since continuous renal replacement therapy (CRRT) in the treatment of sepsis and systemic inflammation response...

Since continuous renal replacement therapy (CRRT) in the treatment of sepsis and systemic inflammation response syndrome (SIRS) showed relatively negative results, attention is now drawn to new membranes and sorbents that could better eliminate massive amounts of unbound mediators in wider spectrum and also in greater magnitude.
This review summarizes the use and evidence of these newly designed technologies i.e. high cutoff CRRT membranes, high non-selective adsorptive CRRT membranes, high selective adsorptive CRRT membranes and cytokine-adsorbing columns.
The authors state, that “CytoSorb might be seen as the most promising although not having the ability to fix endotoxin”.

Moving from a Cytotoxic to a Cytokinic Approach in the Blood Purification Labyrinth: Have We Finally Found Ariadne’s Thread?

Honore PM, Jacobs R, Joannes-Boyau O, Boer W, De Waele E, Van Gorp V, De Regt J, Spapen HD.
Mol Med. 2012 Dec 20;18:1363-5. doi: 10.2119/molmed.2012.00300.

In this article the authors discuss the new “cytokinic” approach introduced by Namas et al...

In this article the authors discuss the new “cytokinic” approach introduced by Namas et al. potentially explaining the mode of action of hemoadsorption using large surface-area polymer (i.e. CytoSorb) compared to the hitherto propagated “cytotoxic” hypotheses.

New membranes for extracorporeal blood purification in septic conditions.

Bello G, Di Muzio F, Maviglia R, Antonelli M
Minerva Anestesiol. 2012 Nov;78(11):1265-81

This review discusses the use of available technologies for extracorporeal blood purification (hemoadsorption, coupled plasma...

This review discusses the use of available technologies for extracorporeal blood purification (hemoadsorption, coupled plasma filtration adsorption, high cut-off- and hemofiltration membranes) in sepsis. The authors specifically address the medical/scientific evidence of CytoSorb, but also of all other procedures.

Clinical review: blood purification for sepsis

Rimmelé T, Kellum JA
Crit Care. 2011;15(1):205. Epub 2011 Feb 16

This review informs about the latest advances in blood purification for sepsis and how they...

This review informs about the latest advances in blood purification for sepsis and how they relate to current concepts of disease. The authors further review the underlying mechanisms and the current medical/scientific evidence for high-volume hemofiltration, cascade hemofiltration, hemoadsorption, coupled plasma filtration adsorption, high-adsorption hemofiltration and high-cutoff hemofiltration/hemodialysis. Though all technologies are biocompatible and effective (reduction of cytokines and in part bacterial toxines, improvement of physiological parameters like hemodynamics and oxygenation), there is an urgent need for confirming large multicenter trials evaluating the ability of these therapies to improve clinical outcomes. Regarding CytoSorb, the authors mainly discuss the two Kellum in vivo studies (endotoxin and cecal ligation and puncture model).

Extracorporeal Therapies in Sepsis

Panagiotou A, Gaiao S, Cruz DN
J Intensive Care Med. 2013 Sep-Oct;28(5):281-95

In this article the authors provide a concise overview of selected extracorporeal modalities (influencing the...

In this article the authors provide a concise overview of selected extracorporeal modalities (influencing the circulating levels of inflammatory mediators like cytokines and chemokines etc.) currently in clinical use (hemofiltration-, adsorption- and cell-based therapies). They also briefly introduce some new promising techniques for sepsis.
CytoSorb is discussed to effectively reduce cytokine levels mainly focussing on the Kellum in vivo study using the cecal ligation and puncture rat model.

Blood purification in sepsis: a new paradigm.

Peng Z, Singbartl K, Simon P, Rimmelé T, Bishop J, Clermont G, Kellum JA
Contrib Nephrol. 2010;165:322-8. Epub 2010 Apr 20

This review gives a good overview on the effects of blood purification therapies at the...

This review gives a good overview on the effects of blood purification therapies at the immunologic and cellular level. It is discussed how therapies like high-volume hemofiltration, hemoadsorption, coupled plasma filtration adsorption and high-cut off membranes have been improved in the meantime and adapted to the “setting” of sepsis.

Clinical review: extracorporeal blood purification in severe sepsis.

Venkataraman R, Subramanian S, Kellum JA
Crit Care. 2003 Apr;7(2):139-45

This review discusses the various modalities of extracorporeal blood purification, the existing evidence and future...

This review discusses the various modalities of extracorporeal blood purification, the existing evidence and future prospects.
Regarding CytoSorb, the authors briefly refer to the known advantages (reduction of cytokine levels, improvement of hemodynamics and survival).