Abstract
BackgroundThough 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.MethodsIn 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.ResultsIntradialytic 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.ConclusionsOL-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.
Highlights
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
Patient demographic data During the study period, 34 of 51 patients admitted to our intensive care unit (ICU) for severe acute kidney injury (AKI) treated by renal replacement therapy (RRT) were included in the study
The present study demonstrated that OL-IHDF achieved an adequate dialysis dose with a fair hemodynamic tolerance in critically ill patients, and was not associated with an increased inflammatory risk
Summary
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. The ideal renal replacement method for intensive care patients remains under scrutiny [2, 3] It should combine the advantages of continuous RRT (CRRT) with those of IHD, be simple to implement and induce minimal work with limited cost. On-line HDF (OL-HDF) is a RRT based on cold sterilization of dialysis fluid to prepare the infusate which is readily administered into the extracorporeal bloodstream. The combined use of synthetic biocompatible membrane and ultrapure dialysis fluid may limit the additional inflammatory risk induced by OL-HDF This potential acute inflammatory risk induced by OL intermittent HDF (OL-IHDF) which remains possible in ICU-AKI has never been evaluated. We designed a study to determine whether OL-IHDF would induce an overproduction of oxidative stress, cytokines and growth factors in critically ill patients
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