TRYPSIN REMOVAL BY CONTINUOUS HEMODIAFILTRATION:

Purpose: Continuous hemodiafiltration (CHDF) has recently been used for the treatment of severe acute pancreatitis. CHDF can filter out pathological mini-molecules with molecular weights below 30 kD. The molecular weight of trypsin is below 26 kD, but when released into the blood, trypsin combines rapidly with protease inhibitors such as a2-macroglobulin (MW: 725 kD) and a1-antitrypsin (MW: 51 kD). Therefore, it may be difficult to remove trypsin by CHDF. In this study, the elimination of trypsin-like enzyme activity (TEA) and trypsin immunoreactivity (TIR) by CHDF was examined in 8 patients with severe acute pancreatitis. Method: CHDF was performed with a polysulfone hemofilter (membrane area of 0.7 m2) at a blood flow rate of 100 ml/min and filtration and dialysis flow rates of 10 ml/min. Nafamostat mesilate, which was used as an anticoagulant, was administered at 30 mg/hr. Results: Before the start of CHDF, the blood TEA and TIR were 3.4 nmol/ml/min and 5.90 μg/ml, respectively. 92.2 % of blood TEA was eliminated after passing through the circuit, and TEA in the waste fluid was not detected. Blood TIR decreased 12.7 % after passing through the circuit, while the TIR decreased 2.4 % with only diafiltration. Conclusion: Trypsin was eliminated by diafiltration and adsorption after passing through the CHDF circuit. If CHDF is performed using nafamostat mesilate as an anticoagulant, the blood TEA can also be suppressed.