Oda Shigeto, Sadahiro Tomohito, Hirayama Yo, Nakamura Masataka, Watanabe Eizo, Tateishi Yoshihisa, Hirasawa Hiroyuki
Contrib Nephrol. 2010;166:47-53. doi: 10.1159/000314851. Epub 2010 May 7.
Continuous renal replacement therapy (CRRT) has been extensively used in Japan as renal support for critically ill patients managed in the ICU. In Japan, active research has also been conducted on non-renal indications for CRRT, i.e. the use of CRRT for purposes other than renal support. Various methods of blood purification have been attempted to remove inflammatory mediators, such as cytokines, in patients with severe sepsis or septic shock. In these attempts, efficacy was demonstrated for continuous hemodiafiltration(CHDF) using a polymethyl methacrylate (PMMA) membrane hemofilter which is capable of adsorbing and removing various cytokines, plasma diafiltration, and online CHDF. Furthermore, a recently developed cytokine-adsorbing column is now under clinical evaluation. Definite evidence for the efficacy of CRRT for non-renal indications has not been established. In evaluating the efficacy of CRRT for non-renal indications, it is essential to focus on patients subjected to be studied, such as severe sepsis or septic shock, and to evaluate its indication, commencement, termination of therapy and also its therapeutic effects based on analysis of blood levels of the target substances to be removed (e.g. cytokines). IL-6 blood level appears to be useful as a variable for this evaluation. It is expected that evidence endorsing the validity of these methods now being attempted in Japan will be reported near future.
连续性肾脏替代治疗（CRRT）在日本已被广泛用于为重症监护病房（ICU）中管理的重症患者提供肾脏支持。在日本，也针对CRRT的非肾脏适应证开展了积极研究，即CRRT用于肾脏支持以外的目的。人们尝试了各种血液净化方法来清除重症脓毒症或脓毒性休克患者体内的炎症介质，如细胞因子。在这些尝试中，使用能够吸附和清除各种细胞因子的聚甲基丙烯酸甲酯（PMMA）膜血液滤过器进行的连续性血液透析滤过（CHDF）、血浆滤过透析以及在线CHDF均显示出疗效。此外，一种最近研发的细胞因子吸附柱目前正在进行临床评估。CRRT用于非肾脏适应证的疗效尚未得到确切证实。在评估CRRT用于非肾脏适应证的疗效时，必须关注所研究的患者，如重症脓毒症或脓毒性休克患者，并基于对要清除的目标物质（如细胞因子）的血药浓度分析来评估其适应证、治疗开始、终止情况以及治疗效果。IL-6血药浓度似乎可作为该评估的一个变量。预计在不久的将来会有报告支持日本目前正在尝试的这些方法的有效性。
