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Kidney Week

Abstract: FR-OR020

Polymyxin Hemoperfusion Shows No Benefits on Kidney Outcomes in Severe Sepsis Patients

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Tungsanga, Somkanya, Chulalongkorn University, Bangkok, Thailand
  • Lumlertgul, Nuttha, Chulalongkorn University, Bangkok, Thailand
  • Thamrongsat, Nicha, Chulalongkorn University, Bangkok, Thailand
  • Peerapornratana, Sadudee, Chulalongkorn University, Bangkok, Thailand
  • Tungsanga, Kriang, Chulalongkorn University, Bangkok, Thailand
  • Srisawat, Nattachai, Chulalongkorn University, Bangkok, Thailand
Background

Polymyxin B Hemoperfusion (PMX-HP) has been introduced as one of the treatments for sepsis over the past 25 years. Previous randomized control trials (RCT) examining the efficacy of PMX-HP reached different conclusions. We aimed to study the effect of PMX-HP on kidney outcomes in patients with severe sepsis.

Methods

An RCT was conducted in sepsis patients who were admitted at intensive care units and had blood endotoxin activity assay (EAA) level ≥ 0.6. They were randomized into 2 groups. The PMX-HP group received standard treatment plus 2-hour PMX-HP for 2 consecutive days whereas the non PMX-HP group received only standard treatment for sepsis. The primary outcome was Major Adverse Kidney Events by 28 days (MAKE28) which consisted of mortality, renal replacement therapy (RRT) status, and persistent renal dysfunction. Secondary outcomes were the mean or median change in mHLA-DR expression, CD11b expression, neutrophil chemotaxis, cardiovascular sequential organ failure assessment (CVS SOFA) score, vasopressor dose, and EAA level between day 3 and day 0. Other parameters included serum creatinine on day 7, ICU free days, and ventilator free days.

Results

59 patients were randomized to PMX-HP (n=29) and non PMX-HP (n=30) groups. At baseline, clinical and immunologic parameters were comparable between groups. The MAKE28 were not significantly different between the two groups, p=1.0. The median change in mHLA-DR expression, parameter of monocyte function, was higher in PMX-HP patients than in non PMX-HP patients, p=0.027. The mean change in CD11b, sparameter of neutrophil activation, was significantly lower in PMX-HP than in non PMX-HP, p=0.002. There were no significant changes in neutrophil chemotaxis, CVS SOFA scores, vasopressor doses, or EAA levels between groups. The serum creatinine on day 7, ICU-free days, and ventilator-free days were comparable between groups.

Conclusion

PMX-HP had no benefits on kidney outcomes in severe sepsis patients. However, it showed beneficial effects on immunomodulation processes. Whether this effects should improve clinical outcomes needs further larger scale clinical trial.

Funding

  • Commercial Support