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Background The evolution of renal replacement therapy (RRT) techniques, and the increasing number of critically ill patients receiving extracorporeal therapies, has presented clinicians with a significant problem: if biomarkers are removed by RRT, can they still be considered reliable in their role of guiding diagnosis and treatment? The most commonly used RRT techniques in intensive care units (ICUs) can be classified into three categories: continuous renal replacement therapy (CRRT), intermittent hemodialysis (IHD), and hybrid techniques such as those performed with sorbent devices and plasma exchange (PE). These techniques remove substances from the plasma via convection, adsorption, or a combination of the two. Various factors determine the degree of removal, including molecular weight (MW) and charge, and the type of membrane and RRT technique used. IHD has a cut-off of 5 kDa in most cases and the risk of eliminating biomarkers is small. For CRRT, the cut-off value of the membranes is about 35 kDa, and as a result, filtration of a significant number of biomarkers may occur. New highly adsorptive membranes (HAMs), such as the acrylonitrile 69-surface treated (AN69-ST), are being used more frequently in ICUs [1]. This means that biomarkers with a MW above 35 kDa, while not

Reliability of biomarkers of sepsis during extracorporeal therapies: the clinician needs to know what is eliminated and what is not