Abstract
Objective: To evaluate the effect of continuous veno venous hemofiltration (CVVH) on neutrophil gelatinase associated lipocalin (NGAL) in critically ill patients with acute kidney injury (AKI). Methods: Critically ill patients with AKI who needed CVVH and admitted to Department of Critical Care Medicine of Peking Union Medical College Hospital were enrolled prospectively from January 2015 to June 2015. AN69 membrane filters were used for CVVH. Prefilter, postfilter,and plasma NGAL measurements were taken at 10 mins, 4 hours and 8 hours (T 10 min, T 4 h, T 8 h) after CVVH. The influence of membrane filter and volume management on NGAL level was analyzed. Results: Forty patients were recruited.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was 22.9±7.0. The sequential organ failure score (SOFA) was 12.1±2.9, and ICU mortality was 27.5%. During CVVH, there were no significant differences in NGAL levels between prefilter [T 10 min:39.3 (24.8, 62.4) μg/min; T 4 h: (45.1±23.2)μg/min; and T 8 h: (45.5±22.4)μg/min] and postfilter [T 10 min: 33.5 (25.1, 60.7) μg/min; T 4 h: (44.2±24.3)μg/min, and T 8 h: (45.9±22.4)μg/min] (P> 0.05 for all). Compared with the survival group[310.0(162.0, 588.0) μg/L], plasma NGAL level in T 10 min [684.0(270.0, 944.0) μg/L] was significantly higher in death group (P= 0.033). After fluid balance correction, T 4 h [603.4(484.8, 620.2) μg/L] and T 8 h [590.2 (475.9, 749.4) μg/L] plasma NGAL levels in death group were significantly higher than those in the survival group [T4 h: 419.5 (227.5, 552.4) μg/L;T 8 h: 400.7(196.1, 517.4) μg/L] with statistical significance (P<0.01 for both). Conclusions: During CVVH, AN69 membrane filter does not have significant effect on plasma NGAL level in critically ill patients with AKI. After volume balance correction, plasma NGAL level could be used as an effective indicator in these patients.
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