Enhanced Vascular Endothelial Growth Factor and Inflammatory Cytokine Removal With Online Hemodiafiltration Over High‐Flux Hemodialysis in Sepsis‐Related Acute Kidney Injury Patients

Abstract

Hypercytokinemia plays a central role in pathogenesis and is related to the high mortality in sepsis-related acute kidney injury (AKI). Besides the established cytokines, vascular endothelial growth factor (VEGF) is demonstrated as an important factor in enhancing vascular leakage in sepsis. This prospective randomized trial was conducted to compare the efficacy of cytokine removal between online hemodiafiltration (HDF), which combines convective and diffusive solute removal, and high-flux hemodialysis (HD). Twenty-eight sepsis-related AKI patients were included and randomized into online HDF and high-flux HD. The percentages of the reduction ratio in plasma cytokines were measured as primary outcomes. Other clinical parameters were determined as secondary outcomes. When compared with high-flux HD, online HDF provided significantly greater percentages of the reduction ratio in plasma cytokine levels, including VEGF (P < 0.001), IL-6 (P = 0.001), IL-8 (P = 0.021), IL-10 (P = 0.011), and tumor necrosis factor-α (P = 0.029). There were no significant differences in intradialytic blood pressures. Online HDF revealed better renal recovery and shorter length of hospitalization than high-flux HD. In conclusion, online HDF in sepsis-related AKI could provide significantly better removal of VEGF and other cytokines and these were associated with better renal outcome than high-flux HD. Thus, online HDF would offer a potential role in hypercytokinemic state in sepsis-related AKI.