Abstract
BackgroundIt 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.MethodsBetween 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.ResultsFollowing 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.ConclusionsThe 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 registrationClinicalTrials.gov, NCT02536027. Retrospectively registered on 20th August 2015.
Highlights
It is known that continuous venonenous hemofiltration (CVVH) does not affect the plasma level of neutrophil gelatinase-associated lipocalin in acute kidney injury (AKI) patients
Plasma neutrophil gelatinase-associated lipocalin, a 25 kDa protein covalently bound to human neutrophil gelatinase, has been confirmed as a reliable biomarker for AKI occurrence and recovery from infectious disease [8,9,10,11]
The urine output and serum creatinine (SCr) parameters were used from the 2012 Kidney Disease Improving Global Outcomes criteria [14], which were based on the Risk, Injury, Failure, Loss, End-stage/Acute Kidney Injury Network definitions
Summary
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. The purpose of this study was to determine the effect of CVVH on pNGAL in sepsis-induced AKI patients. A number of novel biomarkers to help diagnose AKI at an early stage and accurately predict renal recovery have been studied intensively. A recent article by Schilder [12] reported that CVVH did not affect pNGAL in AKI patients due to low filter clearance. Another small series (n = 3) reported that pNGAL was not significantly cleared during CVVH [13]. The aim of the present study was to determine the effect of CVVH on NGAL concentrations in these patients
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