Polymyxin b-immobilized fiber reduces increased plasma endothelin-1 concentrations in hemodialysis patients with sepsis.

We studied whether plasma endothelin (ET)-1 concentrations are altered in patients with septic shock who are undergoing hemodialysis and whether polymyxin B-immobilized fiber (PMX-F) treatment affects on these concentrations. Fifteen hemodialysis patients with septic shock treated with PMX-F (group A), 10 such patients who received conventional treatments (group B), 20 hemodialysis patients without septic shock (group C) and 20 healthy controls (group D) were included in this study. Plasma ET1 levels were measured by radioimmunoassay and endotoxin levels were determined by endospecy test. The survival rate in group A (67%) was higher than that in group B (30%). Blood endotoxin levels decreased significantly from 36.4+/-8.2 pg/mL to 10.6+/-3.8 pg/mL (p < 0.01) after PMX-F treatment in group A. The pretreatment plasma ET-1 levels in patients in group A (58.6+/-9.8 pg/mL) and group B (56.8+/-7.8 pg/mL) were significantly higher than those in group C (p < 0.01) and group D (p < 0.001). Plasma ET-1 levels in group C (11.2+/-3.2 pg/mL) were higher than those in group D (2.6+/-0.6 pg/mL) (p < 0.01). Plasma ET-1 levels following hemodialysis (10.9+/-3.0 pg/mL) were not altered significantly compared with those before hemodialysis. Plasma ET-1 levels decreased significantly in group A after PMX-F treatment (11.4+/-3.6 pg/mL) (p < 0.01); the levels in group B were not altered after conventional treatment. Our data suggest that ET-1 may be associated with septic shock in patients undergoing hemodialysis and that PMX-F is effective in reducing plasma ET-1 levels in these patients.