Kenshi Moriwaki

Newly Developed Immobilized Polymyxin B Fibers Improve the Survival of Patients with Sepsis

Background: Sepsis and septic shock are still major causes of morbidity and mortality in spite of the availability of powerful and broadly active antibiotics. Methods: A prospective, open and randomized trial of the effect of immobilized polymyxin fibers (PMX-F) on the survival of patients with sepsis throughout a follow-up period of 28 days or until discharge, if earlier, was carried out. Ninety-eight patients were included who met at least 4 of the criteria for systemic inflammatory response syndrome due to infection. The patients were classified into three groups based on their Acute Physiology and Chronic Health Evaluation (APACHE) II score. Results: The overall survival rate was significantly improved by using PMX-F compared to the control group (41 vs. 11%) (p = 0.002). In patients with an APACHE II score less than 20, treatment with PMX-F was shown to improve outcome (65 vs. 19%) (p = 0.01). In cases of more severe sepsis with an APACHE II score of 20–29, PMX-F still maintained efficacy in improving outcome (40 vs. 11%) (p = 0.04). However, PMX-F treatment did not improve the survival rate in patients with an APACHE II score of greater than 30 (survival rate 7 vs. 0%) (p = 0.59). Conclusion: From these results, it is concluded that treatment with PMX-F in patients with sepsis is effective and prolongs the survival rate when applied at an early stage of sepsis. However, in severe sepsis, this therapy does not improve the survival rate.

BLOOD PRESSURE REDUCTION IN THE MORNING YIELDS BENEFICIAL EFFECTS ON PROGRESSION OF CHRONIC RENAL INSUFFICIENCY WITH REGRESSION OF LEFT VENTRICULAR HYPERTROPHY

Self-monitoring values of blood pressure may better reflect the average long-term blood pressure value than sporadic measurements in the physicians office and be more useful for blood pressure control. In the present study, we compared the results of self-monitoring of blood pressure values, especially in the morning, with office blood pressure, and related these to progression of chronic renal insufficiency and left ventricular hypertrophy (LVH). Thirty-four patients were selected from 316 subjects with chronic renal insufficiency (average serum creatinine 1.72 ± 0.15 mg/dl, mean age 52.6 ± 3.5 yrs) in accordance with the following criteria 1 office blood pressure was less than 140/90 mmHg, 2 blood pressure was controlled with amlodipine (5–20 mg/day) combined with benazepril (2.5 mg/day), 3 morning blood pressure was greater than 150/90 mmHg at 6–9 AM and 4 LVH had been determined by echocardiography (posterior wall thickness; PWT ≥ 12 mm). The patients were assigned to 2 groups at random and were given: 1 guanabenz (GB; 2–8 mg at 11 PM, n = 17) or 2 placebo (n = 17). Two years later, the average blood pressure of both groups as measured in the office was not significantly different: however, BP in the morning was significantly reduced from 158 ± 6 to 134 ± 4 mmHg in GB treated group (P < 0.001). In 14 of 17 patients in GB treated group, LVH resolved and there was only mild progression of nephropathy (serum creatinine: 1.69 ± 0.18 to 1.81 ± 0.19 mg/dl). In 12 of 14 patients in placebo group, whose morning blood pressure remained at greater than 150/90 mmHg, LVH was retained and there was moderate progression of nephropathy (serum creatinine: 1.73 ± 0.14 to 2.62 ± 0.50 mg/dl). From these results, it is suggested that antihypertensive treatment with combination therapy based on self-monitoring BP is cardio-renoprotective in patients with chronic renal insufficiency and LVH.

2nd International Congress of the Vascular Access Society / Author Index for Abstracts

May 30 to June 1, 2001, London