On-line hemodiafiltration did not induce an overproduction of oxidative stress and inflammatory cytokines in intensive care unit-acute kidney injury

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.

Intermittent hemodiafiltration as a down-step transition therapy in patients with acute kidney injury admitted to intensive care unit who initially underwent continuous venovenous hemodiafiltration

“…They did not observe increase in plasmatic dosage of cytokines (IL1ß, IL4, IL6, IL8, IL10, IFN γ), growing factors ( Epidermal growth factor —EGF, Vascular Endothelial growth factor —VEGF) and MCP-1 (Macrophage Chemoattractant Protein-1). 11 We did not observe any episode of pyrogenic reaction or bacteremia during the observational period of our study. Microbiology conformity was obtained in all samples; however, a small number of treatment and samples could influence the results.…”

“…20 Klouche et al observed similar rates from percentage reduction from Cystatin C and β-2 microglobulin in critically ill patients with AKI who underwent an on-line HDF: 44.5% and 51.5%, respectively. 11 Removal of middle molecules is higher in HDF compared with high flux IHD, 20–22 however, a target was not established for blood levels reduction of these substances in patients with AKI.…”

Anti-apoptosis mechanism of triptolide based on network pharmacology in focal segmental glomerulosclerosis rats

“…IL-4 is an anti-inflammatory factor that belongs to the interleukin family [19]. It has been reported that IL4 can inhibit apoptosis of liver cancer cells, and blockage of the IL4/IL4R/STAT6 axis can promote apoptosis of Hodgkin lymphoma cells [20].…”

Oxidative Status before and after Renal Replacement Therapy: Differences between Conventional High Flux Hemodialysis and on-Line Hemodiafiltration

“…Nonetheless, little is known about the oxidative status in patients under OL-HDF. Klouche et al recently described that inflammation is not affected by OL-HDF and that advanced oxidation protein products are reduced in the process [46]. This would lead to an attenuation in oxidative stress in these patients, which could contribute to their improved survival.…”