Department of Pediatrics, Division of Critical Care, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University, Nashville, Tenn. 37232-3467, USA.
Blood Purif. 2009;28(4):348-53. doi: 10.1159/000232936. Epub 2009 Sep 1.
BACKGROUND/AIMS: Etanercept is a tumor necrosis factor-alpha antagonist used in inflammation-mediated conditions. Continuous venovenous hemofiltration (CVVH) has also been used in patients with inflammatory conditions. This study evaluated etanercept clearance using an in vitro CVVH model.
Etanercept clearance was assessed in vitro in bovine blood at 1-3 mg/l final serum concentration, and urea control at 750 mg/l. CVVH was performed using polyacrylonitrile, polysulfone, and polymethylmethacrylate filters at 3 l/h ultrafiltrate and 200 ml/min blood flow rates. Transmembrane clearance was estimated using sieving coefficient calculations, and adsorptive removal rate was approximated using a mass balance calculation.
Urea sieving coefficient remained constant (1.04 +/- 0.01). Ultrafiltrate etanercept concentrations were undetectable (sieving coefficient < 0.02) and transmembrane and adsorptive clearances were negligible.
Etanercept is not cleared appreciably by transmembrane or adsorptive mechanisms in CVVH using polyacrylonitrile, polysulfone, or polymethylmethacrylate hemofilters.
背景/目的：依那西普是一种肿瘤坏死因子-α拮抗剂，用于炎症介导的疾病。连续静脉-静脉血液滤过（CVVH）也已用于炎症性疾病患者。本研究通过体外 CVVH 模型评估了依那西普的清除率。
在最终血清浓度为 1-3mg/l 的牛血液中，以及最终血清浓度为 750mg/l 的尿素对照物中，进行体外依那西普清除率评估。使用丙烯腈、聚砜和聚甲基丙烯酸甲酯过滤器以 3l/h 的超滤液和 200ml/min 的血流速率进行 CVVH。通过筛分系数计算估计跨膜清除率，并通过质量平衡计算近似估计吸附性清除率。
尿素的筛分系数保持不变（1.04±0.01）。超滤液中的依那西普浓度无法检测到（筛分系数<0.02），且跨膜和吸附性清除率可忽略不计。
在使用丙烯腈、聚砜或聚甲基丙烯酸甲酯血液滤器的 CVVH 中，依那西普不能通过跨膜或吸附机制被大量清除。
