The effect of continuous venovenous hemofiltration on neutrophil gelatinase-associated lipocalin plasma levels in patients with septic acute kidney injury

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Background:
It is known that continuous venonenous hemofiltration (CVVH) does not affect the plasma level of neutrophil gelatinase-associated lipocalin (pNGAL) in acute kidney injury (AKI) patients. However, because of the unique pathophysiology underlying AKI caused by sepsis, the effect of CVVH on pNGAL in this clinical setting is less certain. The purpose of this study was to determine the effect of CVVH on pNGAL in sepsis-induced AKI patients.

Methods:
Between August 1, 2014, and December 31, 2014, 42 patients with sepsis-induced AKI underwent CVVH in the general intensive care unit of our institution and were consecutively enrolled in this study. Prefilter, postfilter, and ultrafiltrate pNGAL measurements were taken at the initiation of continuous renal replacement therapy (CRRT) and repeated after 2, 4, 8, and 12 h (T0, T2h, T4h, T8h, and T12h, respectively). The mass transfer, plasma clearance, and sieving coefficient were calculated based on the mass conservation principle.

Results:
Following CVVH initiation, we found that pNGAL in the ultrafiltrate decreased significantly (P = 0.013); however, levels at the inlet and outlet showed no significant change (P > 0.05 for both). Furthermore, there was no change in the total mass removal rate, total mass adsorption rate, and plasma clearance over time (P > 0.05 for all), and a significant decrease in the sieving coefficient (P = 0.007) was seen.

Conclusions:
The results of this study show a limited effect of CVVH on pNGAL in sepsis-induced AKI patients. This suggests that pNGAL may be used as an indicator of renal progression in these patients. However, a larger study to confirm these findings is needed.

Trial registration:
ClinicalTrials.gov, NCT02536027. Retrospectively registered on 20th August 2015.

Keywords:
Acute kidney injury, Continuous venovenous hemofiltration, Neutrophil gelatinase-associated lipocalin, Sepsis

Autoři: Xingui Dai† ^1,2; Tao Li† ²; Zhenhua Zeng† ¹; Chunlai Fu ²; Shengbiao Wang ²; Yeping Cai ²; Zhongqing Chen ^1*
Působiště autorů: Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, Guangdong 510515, China. ¹; Department of Critical Care Medicine, the First Peoples’ Hospital of Chenzhou, Institute of Translation Medicine, 102 Luo Jia Jin Street, Chenzhou, Hunan 423000, China. ²
Vyšlo v časopise: BMC Nefrol 2016, 17:154
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1186/s12882-016-0363-y

© 2016 The Author(s).

Open access
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The electronic version of this article is the complete one and can be found online at: http://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-016-0363-y

Souhrn

Trial registration:
ClinicalTrials.gov, NCT02536027. Retrospectively registered on 20th August 2015.

Keywords:
Acute kidney injury, Continuous venovenous hemofiltration, Neutrophil gelatinase-associated lipocalin, Sepsis

Zdroje

1. Hoste EA, Lameire NH, Vanholder RC, Benoit DD, Decruyenaere JM, Colardyn FA. Acute renal failure in patients with sepsis in a surgical ICU: predictive factors, incidence, comorbidity, and outcome. J Am Soc Nephrol. 2003;14:1022–30.

2. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294:813–18.

3. Shemesh O, Golbetz H, Kriss JP, Myers BD. Limitations of creatinine as a filtration marker in glomerulopathic patients. Kidney Int. 1985;28:830–8.

4. Stevens LA, Coresh J, Greene T, Levey AS. Assessing kidney function-measured and estimated glomerular filtration rate. N Engl J Med. 2006;354:2473–83.

5. Uchino S, Bellomo R, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, et al. Discontinuation of continuous renal replacement therapy: a post hoc analysis of a prospective multicenter observational study. Crit Care Med. 2009;37:2576–82.

6. Zarbock A, Gomez H, Kellum JA. Sepsis-induced acute kidney injury revisited: pathophysiology, prevention and future therapies. Curr Opin Crit Care. 2014;20:588–95.

7. Gomez H, Ince C, De Backer D, Pickkers P, Payen D, Hotchkiss J, Kellum JA. A unified theory of sepsis-induced acute kidney injury: inflammation, microcirculatory dysfunction, bioenergetics, and the tubular cell adaptation to injury. Shock. 2014;41:3–11.

8. Kim H, Hur M, Cruz DN, Moon HW, Yun YM. Plasma neutrophil gelatinaseassociated lipocalin as a biomarker for acute kidney injury in critically ill patients with suspected sepsis. Clin Biochem. 2013;46:1414–8.

9. Dai X, Zeng Z, Fu C, Zhang S, Cai Y, Chen Z. Diagnostic value of neutrophil gelatinase-associated lipocalin, cystatin C, and soluble triggering receptor expressed on myeloid cells-1 in critically ill patients with sepsis-associated acute kidney injury. Crit Care. 2015;19:223.

10. Camou F, Oger S, Paroissin C, Guilhon E, Guisset O, Mourissoux G, Pouyes H, Lalanne T, Gabinski C. Plasma Neutrophil Gelatinase-Associated Lipocalin (NGAL) predicts acute kidney injury in septic shock at ICU admission. Ann Fr Anesth Reanim. 2013;32:157–64.

11. Srisawat N, Murugan R, Lee M, Kong L, Carter M, Angus DC, Kellum JA. Plasma neutrophil gelatinase-associated lipocalin predicts recovery from acute kidney injury following community-acquired pneumonia. Kidney Int. 2011;80:545–52.

12. Schilder L, Nurmohamed SA, ter Wee PM, Paauw NJ, Girbes AR, Beishuizen A, Beelen RH, Groeneveld AB. The plasma level and biomarker value of neutrophil gelatinase-associated lipocalin in critically ill patients with acute kidney injury are not affected by continuous venovenous hemofiltration and anticoagulation applied. Crit Care. 2014;18:R78.

13. de Geus HR, Betjes MG, Bakker J. Neutrophil gelatinase-associated lipocalin clearance during veno-venous continuous renal replacement therapy in critically ill patients. Intensive Care Med. 2010;36:2156–7.

14. Palevsky PM, Liu KD, Brophy PD, Chawla LS, Parikh CR, Thakar CV, Tolwani AJ, Waikar SS, Weisbord SD. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for acute kidney injury. Am J Kidney Dis. 2013;61:649–72.

15. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003;31:1250–6.

16. Vanmassenhove J, Glorieux G, Lameire N, Hoste E, Dhondt A, Vanholder R, Van Biesen W. Influence of severity of illness on neutrophil gelatinaseassociated lipocalin performance as a marker of acute kidney injury: a prospective cohort study of patients with sepsis. BMC Nephrol. 2015;16:18.

17. Donadio C. Dialysis with high-flux membranes significantly affects plasma levels of neutrophil gelatinase-associated lipocalin. Crit Care. 2016;20:20.

18. Simmons J, Pittet JF. The coagulopathy of acute sepsis. Curr Opin Anaesthesiol. 2015;28:227–36.