Kinetics of plasmatic cytokines and cystatin C during and after hemodialysis in septic shock-related acute renal failure

Abstract

IntroductionCystatin C could be a relevant residual glomerular filtration rate marker during hemodialysis (HD), and a high cytokine plasma (p) rate is associated with an increase in mortality during sepsis. To the best of our knowledge, cytokines and cystatin C kinetics during and after HD during sepsis have never been studied. In this study, we described p cytokines and cystatin C variations during and after hemodialysis in septic-shock patients with acute kidney injury (AKI).MethodsTen patients, from two tertiary ICUs, with septic shock-related AKI, according to RIFLE class F, were studied. In this prospective observational study, blood samples were collected at the start, after 1 hour, 2 hours, and at the end of HD with a polymethymethacrylate (PMMA) hemodialyzer (D0, D1, D2, and endD), and 30, 60, 90, 120, and 180 min after HD (postD0.5, postD1, postD1.5, postD2, and postD3). We measured p interleukins (IL)-6, IL-8, IL-10, cystatin C, and albumin. Results are expressed as variations from D0 (mean ± SD).ResultsDuring HD, p[IL-6] did not vary significantly, whereas p[IL-8] and p[IL-10] reductions by D1 were 31.8 ± 21.2% and 36.3 ± 26%, respectively (P < 0.05 as compared with D0). At postD3, p[IL-8] and p[IL-10] returned to their initial values. p[Cystatin C] was significantly reduced from D1 to postD1, with a maximal reduction of 30 ± 6.7% on D2 (P < 0.05). Norepinephrine infusion rate decreased from D0 to postD3 (0.65 ± 0.39 to 0.49 ± 0.37 μg/kg/min; P < 0.05).ConclusionsHD allows a transient and selective decrease in p cytokines, which are known as being correlated with mortality during septic shock. Because of a significant decrease in p cystatin C during HD, this should not be considered as an accurate marker for residual glomerular filtration rate during septic acute renal failure when receiving HD with a PMMA hemodialyzer.

Cystatin C is not a reliable marker of residual glomerular filtration rate during continuous renal replacement therapy

“…In a previous study, 3 h of intermittent hemodialysis using a polymethylmethacrylate filter decreased cystatin C concentrations by 30 ± 7% [5]. This supports the hypothesis that in different types of renal replacement therapy serum cystatin C concentrations are reduced.…”

A novel conditional platelet depletion mouse model reveals the importance of platelets in protection against Staphylococcus aureus bacteremia

“…It is apparent from blood chemistry analysis that PF4‐DTR mice suffered from more extensive kidney damage than WT mice, and this correlated with an increased bacterial burden in kidney. As acute kidney injury/failure contributes to the mortality of sepsis and septic shock , we found it interesting that PF4‐DTR mice had significantly more bacterial colonization than WT mice. It has been reported that platelets can encapsulate bacteria and facilitate their transport to immune effector cells , and that platelets can internalize and kill bacteria .…”

Diagnostic value of neutrophil gelatinase-associated lipocalin, cystatin C, and soluble triggering receptor expressed on myeloid cells-1 in critically ill patients with sepsis-associated acute kidney injury

“…In the study by Mayeur et al . [ 37 ], 3 hours of intermittent hemodialysis decreased the Cys-C concentrations by 30%. This confirmed that the serum Cys-C concentrations are altered in patients who undergo RRT.…”