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Observational Study
. 2017 Dec 22;18(1):371.
doi: 10.1186/s12882-017-0785-1.

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

Kada Klouche  1   2 , Laurent Amigues  3 , Marion Morena  4   5 , Vincent Brunot  3 , Anne Marie Dupuy  4 , Audrey Jaussent  6 , Marie Christine Picot  6 , Noémie Besnard  3 , Delphine Daubin  3 , Jean Paul Cristol  4   5
Affiliations
Observational Study

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

Kada Klouche et al. BMC Nephrol. .

Abstract

Background: 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.

Methods: In 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.

Results: Intradialytic 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.

Conclusions: OL-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.

Keywords: Acute kidney injury; Anti-inflammatory cytokines; Egf; Inflammatory cytokines; Mcp-1; On-line Hemodiafiltration; Oxidative stress; Vegf.

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Conflict of interest statement

Ethics approval and consent to participate

This observational prospective study was carried out at the Medical ICU of Lapeyronie University Hospital at Montpellier and was approved by the Ethics Research Committee of our hospital; PHRC régional: N° 2006-A00510–51. A written informed consent was obtained from the patients. If the patient has not the capability to give consent, a written informed consent was obtained from its closest relative. All the patients confirmed their consent by writing later on.

Consent for publication

Not applicable.

Competing interests

The authors’ declare that they have no competing interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Anion superoxide production (a), superoxide activation rate (b), and advanced oxidation protein products plasmatic levels (c) before and after OL-IHDF sessions. Values are shown as mean and standard deviation. Phorbol 12-myristate 13-acetate (PMA), On-line intermittent hemodiafiltration (OL-IHDF)
Fig. 2
Fig. 2
Mean plasmatic concentrations of pro-inflammatory cytokines before and after OL-IHDF sessions. Values are shown as mean and standard deviation. On-line intermittent hemodiafiltration (OL-IHDF), Interleukin 6 (IL6), Interleukin 8 (IL8), Interferon γ (infγ), Interleukin 1β (IL1β)
Fig. 3
Fig. 3
Mean plasmatic concentrations of anti-inflammatory cytokines and TNFα before and after OL-IHDF sessions. Values are shown as mean and standard deviation. Interleukin 4 (IL4), Interleukin 10 (IL10), Tumor Necrosis Factor alpha (TNFα)
Fig. 4
Fig. 4
Mean plasmatic concentrations of Endothelial Growth factor (EGF), Vascular Endothelial Growth factor (VEGF), Macrophage Chemoattractive protein 1 (MCP-1) before and after OL-IHDF sessions. Values are shown as mean and standard deviation
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