It has been claimed humoral mediator network including pro-inflammatory cytokines plays a pivotal role in the pathophysiology of SAP. On the other hands, we have reported CHDF using polymethyl methacrylate (PMMA) membrane hemofilter could remove cytokines in blood of a patient continuously and effectively. Therefore, we applied CHDF to patients with SAP. CHDF was performed using a PMMA-hemofilter for removal of causative cytokines regardless of renal function 24 hours a day without interruption until IL-6 blood level became below 400 pg/ml. Selective digestive decontamination (SDD) was also given for prevention of bacterial translocation. Forty-two out of 45 patients (93%) receiving both CHDF and SDD survived. We conclude critical care with PMMA-CHDF and SDD is an effective treatment for SAP.