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Open Access 01-12-2017 | Research article

On-line hemodiafiltration did not induce an overproduction of oxidative stress and inflammatory cytokines in intensive care unit-acute kidney injury

Authors: Kada Klouche, Laurent Amigues, Marion Morena, Vincent Brunot, Anne Marie Dupuy, Audrey Jaussent, Marie Christine Picot, Noémie Besnard, Delphine Daubin, Jean Paul Cristol

Published in: BMC Nephrology | Issue 1/2017

Abstract

Background

Though on-line intermittent hemodiafiltration (OL-IHDF) is a routine therapy for chronic dialysis patients, it is not yet widespread used in critically ill patients. This study was undergone to evaluate efficiency and tolerance of OL-IHDF and to appreciate inflammatory consequences of its use in intensive care unit (ICU)-acute kidney injury (AKI) patients.

Methods

In this prospective cohort study conducted in a medical academic ICU in France, 30 AKI patients who underwent OL-IHDF were included. OL-HDF used an ultrapure water production: AQ 1250 line with double reverse osmosis, a generator 5008 with a 1.8m² dialyzer with Polysulfone membrane (Fresenius Medical Care). Tolerance and efficiency of OL-IHDF were evaluated as well as its inflammatory risk by the measurement of plasma concentrations of proinflammatory (Interleukin 6, IL1β, IL8, Interferon γ) and anti-inflammatory (IL4, IL10) cytokines, Epidermal growth factor (EGF), Vascular Endothelial growth factor (VEGF) and Macrophage Chemoattractive Protein-1 (MCP-1) before and after sessions.

Results

Intradialytic hypotensive events were observed during 27/203 OL-IHDF sessions accounting for a mal-tolerated session’s rate at 13.3%. Mean delivered urea Kt/V per session was 1.12 ± 0.27 with a percentage of reduction for urea, creatinine, β2-microglobulin and cystatine C at 61.6 ± 8.8%, 55.3 ± 6.7%, 51.5 ± 8.7% and 44.5 ± 9.8% respectively. Production of superoxide anion by leukocytes, mean levels of pro- and anti-inflammatory cytokines and plasmatic concentrations of EGF, VEGF and MCP-1 did not differ before and after OL-IHDF sessions. We observed however a significant decrease of mean TNFα plasmatic concentrations from 8.2 ± 5.8 to 4.8 ± 3.5 pg/ml at the end of OL-IHDF.

Conclusions

OL-IHDF was not associated with an increase in pro and anti-inflammatory cytokines, oxidative stress or EGF, VEGF and MCP-1 in AKI patients and seems therefore a secure and feasible modality in ICUs.

Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294:813–8.CrossRefPubMed

Vinsonneau C, Camus C, Combes A, Costa de Beauregard MA, Klouche K, Boulain T, et al. Continuous venovenous haemodiafiltration versus intermittent haemodialysis for acute renal failure in patients with multiple-organ dysfunction syndrome: a multicentre randomised trial. Lancet. 2006;368:379–85.CrossRefPubMed

Mehta RL, McDonald B, Gabbai FB, Pahl M, Pascual MT, Farkas A, et al. A randomized clinical trial of continuous versus intermittent dialysis for acute renal failure. Kidney Int. 2001;60:1154–63.CrossRefPubMed

Saudan P, Niederberger M, De Seigneux S, Romand J, Pugin J, Perneger T, et al. Adding a dialysis dose to continuous hemofiltration increases survival in patients with acute renal failure. Kidney Int. 2006;70:1312–7.CrossRefPubMed

Marshall MR, Ma T, Galler D, Rankin APN, Williams AB. Sustained low-efficiency daily diafiltration (SLEDD-f) for critically ill patients requiring renal replacement therapy: towards an adequate therapy. Nephrol Dial Transplant. 2004;19:877–84.CrossRefPubMed

Abe M, Okada K, Suzuki M, Nagura C, Ishihara Y, Fujii Y, et al. Comparison of sustained hemodiafiltration with continuous venovenous hemodiafiltration for the treatment of critically ill patients with acute kidney injury. Artif Organs. 2010;34:331–8.CrossRefPubMed

Kron J, Kron S, Wenkel R, Schuhmacher H-U, Thieme U, Leimbach T, et al. Extended daily on-line high-volume haemodiafiltration in septic multiple organ failure: a well-tolerated and feasible procedure. Nephrol Dial Transplant. 2012;27:146–52.CrossRefPubMed

Nistor I, Palmer SC, Craig JC, Saglimbene V, Vecchio M, Covic A, Strippoli GF. Convective versus diffusive dialysis therapies for chronic kidney failure: an updated systematic revierw of randomized controlled trials. Am J Kidney Dis. 2014;63:954–67.CrossRefPubMed

Nistor I, Palmer SC, Craig JC, Saglimbene V, Vecchio M, Covic A, Strippoli GF. Haemodiafiltration, haemofiltration and haemodialysis for end-stage kidney disease. Cochrane Database Syst Rev. 2015;5:CD006258.

10.

Morena M, Jaussent A, Chalabi L, Leray-Moragues H, Chenine L, Debure A, Thibaudin D, et al. Treatment tolerance and patient-reported outcomes favor online hemodiafiltration compared to high-flux hemodialysis in the elderly. Kidney Int. 2017;17:30040–6.

11.

Klouche K, Amigues L, Serveaux-Delous M, Machado S, Delabre J-P, Laydet E, et al. Implementing on-line hemodiafiltration as a renal replacement therapy for ICU acute renal failure: a single-center report of feasibility, safety and hemodynamic tolerance over a seven-year period. Blood Purif. 2012;34:10–7.CrossRefPubMed

12.

Pettilä V, Tiula E. Intermittent hemodiafiltration in acute renal failure in critically ill patients. Clin Nephrol. 2001;56:324–31.PubMed

13.

Laurent I, Adrie C, Vinsonneau C, Cariou A, Chiche J-D, Ohanessian A, et al. High-volume hemofiltration after out-of-hospital cardiac arrest: a randomized study. J Am Coll Cardiol. 2005;46:432–7.CrossRefPubMed

14.

Kawanishi H. On-line hemodiafiltration in critical care. Ther Apher. 2002;6:199–203.CrossRefPubMed

15.

Kawanishi H. On-line continuous hemodiafiltration in sepsis. Transfus Apher Sci. 2006;35:265–9.CrossRefPubMed

16.

Kumar VA, Yeun JY, Depner TA, Don BR. Extended daily dialysis vs. continuous hemodialysis for ICU patients with acute renal failure: a two-year single center report. Int J Artif Organs. 2004;27:371–9.PubMed

17.

Kielstein JT, Kretschmer U, Ernst T, Hafer C, Bahr MJ, Haller H, et al. Efficacy and cardiovascular tolerability of extended dialysis in critically ill patients: a randomized controlled study. Am J Kidney Dis. 2004;43:342–9.CrossRefPubMed

18.

Le Gall JR, Lemeshow S, Saulnier F. A new simplified acute physiology score (SAPS II) based on a European/north American multicenter study. JAMA. 1993;270:2957–63.CrossRefPubMed

19.

Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the working group on sepsis-related problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22:707–10.CrossRefPubMed

20.

KDIGO AKI Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;17:1–138.

21.

Canaud B, Bosc JY, Leray H, Stec F, Argiles A, Leblanc M, et al. On-line haemodiafiltration: state of the art. Nephrol Dial Transplant. 1998;13(Suppl 5):3–11.CrossRefPubMed

22.

Canaud B, Bosc JY, Leray H, Stec F. Microbiological purity of dialysate for on-line substitution fluid preparation. Nephrol Dial Transplant. 2000;15(Suppl 2):21–30.CrossRef

23.

Pegues DA, Oettinger CW, Bland LA, Oliver JC, Arduino MJ, Aguero SM, et al. A prospective study of pyrogenic reactions in hemodialysis patients using bicarbonate dialysis fluids filtered to remove bacteria and endotoxin. J Am Soc Nephrol. 1992;3:1002–7.PubMed

24.

NKF-DOQI clinical practice guidelines for hemodialysis adequacy. Am J Kidney Dis. 1997;30:suppl2 S38-S42.

25.

Bergström J, Wehle B. No change in corrected beta 2-microglobulin concentration after cuprophane haemodialysis. Lancet. 1987;1:628–9.CrossRefPubMed

26.

Daugirdas JT. Second generation logarithmic estimates of single-pool variable volume Kt/V: an analysis of error. J Am Soc Nephrol. 1993;4:1205–13.PubMed

27.

Badiou S, Dupuy AM, Descomps B, Cristolead JP. Comparison between the enzymatic vitros assay for creatinine determination and three other methods adapted on the Olympus analyzer. J Clin Lab Anal. 2003;17:235–40.CrossRefPubMed

28.

Ventura E, Durant R, Jaussent A, Picot M-C, Morena M, Badiou S, et al. Homocysteine and inflammation as main determinants of oxidative stress in the elderly. Free Radic Biol Med. 2009;46:737–44.CrossRefPubMed

29.

Dupuy AM, Lehmann S, Cristol JP. Protein biochip systems for the clinical laboratory. Clin Chem Lab Med. 2005;43:1291–302.PubMed

30.

Witko-Sarsat V, Friedlander M, Capeillère-Blandin C, Nguyen-Khoa T, Nguyen AT, Zingraff J, et al. Advanced oxidation protein products as a novel marker of oxidative stress in uremia. Kidney Int. 1996;49:1304–13.CrossRefPubMed

31.

Delample D, Durand F, Severac A, Belghith M, Mas E, Michel F, et al. Implication of xanthine oxidase in muscle oxidative stress in COPD patients. Free Radic Res. 2008;42:807–14.CrossRefPubMed

32.

Canaud B, Barbieri C, Marcelli D, Bellocchio F, Bowry S, Mari F, et al. Optimal convection volume for improving patient outcomes in an international incident dialysis cohort treated with online hemodiafiltration. Kidney Int. 2015;88:1108–16.CrossRefPubMedPubMedCentral

33.

Tsuchida K, Takemoto Y, Yamagami S, Edney H, Niwa M, Tsuchiya M, et al. Detection of peptidoglycan and endotoxin in dialysate, using silkworm larvae plasma and limulus amebocyte lysate methods. Nephron. 1997;75:438–43.CrossRefPubMed

34.

Schindler R, Krautzig S, Lufft V, Lonnemann G, Mahiout A, Marra MN, et al. Induction of interleukin-1 and interleukin-1 receptor antagonist during contaminated in-vitro dialysis with whole blood. Nephrol Dial Transplant. 1996;11:101–8.CrossRefPubMed

35.

Simmons EM, Himmelfarb J, Sezer MT, Chertow GM, Mehta RL, Paganini EP, et al. Plasma cytokine levels predict mortality in patients with acute renal failure. Kidney Int. 2004;65:1357–65.CrossRefPubMed

36.

Chawla LS, Seneff MG, Nelson DR, Williams M, Levy H, Kimmel PL, et al. Elevated plasma concentrations of IL-6 and elevated APACHE II score predict acute kidney injury in patients with severe sepsis. Clin J Am Soc Nephrol. 2007;2:22–30.CrossRefPubMed

37.

Selmeci L, Seres L, Antal M, Lukács J, Regöly-Mérei A, Acsády G. Advanced oxidation protein products (AOPP) for monitoring oxidative stress in critically ill patients: a simple, fast and inexpensive automated technique. Clin Chem Lab Med. 2005;43:294–7.CrossRefPubMed

38.

Lentini P, de Cal M, Cruz D, Chronopoulos A, Soni S, Nalesso F, et al. The role of advanced oxidation protein products in intensive care unit patients with acute kidney injury. J Crit Care. 2010;25:605–9.CrossRefPubMed

39.

Du S, Zeng X, Tian J, Ai J, Wan J, He J. Advanced oxidation protein products in predicting acute kidney injury following cardiac surgery. Biomarkers. 2015;20:206–11.CrossRefPubMed

40.

Li HY, Hou FF, Zhang X, Chen PY, Liu SX, Feng JX, et al. Advanced oxidation protein products accelerate renal fibrosis in a remnant kidney model. J Am Soc Nephrol. 2007;18:528–38.CrossRefPubMed

41.

Vaslaki L, Weber C, Mitteregger R, Falkenhagen D. Cytokine induction in patients undergoing regular online hemodiafiltration treatment. Artif Organs. 2000;24:514–8.CrossRefPubMed

42.

Kadiroglu AK, Sit D, Atay AE, Kayabasi H, Altintas A, Yilmaz ME. The evaluation of effects of demographic features, biochemical parameters, and cytokines on clinical outcomes in patients with acute renal failure. Ren Fail. 2007;29:503–8.CrossRefPubMed

43.

Tamme K, Maddison L, Kruusat R, Ehrlich HE, Viirelaid M, Kern H, Starkopf J. Effects of high volume haemodiafiltration on inflammatory response profile and microcirculation in patients with septic shock. BioMed Research International. 2015; 125615. doi: 10.1155/2015/125615.

44.

van der Flier M, van Leeuwen HJ, van Kessel KP, Kimpen JL, Hoepelman AI, Geelen SP. Plasma vascular endothelial growth factor in severe sepsis. Shock. 2005;23:35–8.CrossRefPubMed

45.

Pickkers P, Sprong T, van Eijk L, van der Hoeven H, Smits P, van Deuren M. Vascular endothelial growth factor is increased during the first 48 hours of human septic shock and correlates with vascular permeability. Shock. 2005;24:508–12.CrossRefPubMed

46.

Chancharoenthana W, Tiranathanagul K, Srisawat N, Susantitaphong P, Leelahavanichkul A, Praditpornsilpa K, et al. Enhanced vascular endothelial growth factor and inflammatory cytokine removal with online hemodiafiltration over high-flux hemodialysis in sepsis-related acute kidney injury patients. Ther Apher Dial. 2013;17:557–63.

47.

The VA/NIH Acute Renal Failure Trial Network. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008;359:7–20.CrossRefPubMedCentral

Title: On-line hemodiafiltration did not induce an overproduction of oxidative stress and inflammatory cytokines in intensive care unit-acute kidney injury
Authors: Kada Klouche
Laurent Amigues
Marion Morena
Vincent Brunot
Anne Marie Dupuy
Audrey Jaussent
Marie Christine Picot
Noémie Besnard
Delphine Daubin
Jean Paul Cristol
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: BMC Nephrology / Issue 1/2017
Electronic ISSN: 1471-2369
DOI: https://doi.org/10.1186/s12882-017-0785-1

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Conclusions

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