Enhanced vascular endothelial growth factor and inflammatory cytokine removal with online hemodiafiltration over high-flux hemodialysis in sepsis-related acute kidney injury patients.

Abstract

Hypercytokinemia plays a central role in pathogenesis and is related to the high mortality in sepsis-related acute kidney injury (AKI). Besides the established cytokines, vascular endothelial growth factor (VEGF) is demonstrated as an important factor in enhancing vascular leakage in sepsis. This prospective randomized trial was conducted to compare the efficacy of cytokine removal between online hemodiafiltration (HDF), which combines convective and diffusive solute removal, and high-flux hemodialysis (HD). Twenty-eight sepsis-related AKI patients were included and randomized into online HDF and high-flux HD. The percentages of the reduction ratio in plasma cytokines were measured as primary outcomes. Other clinical parameters were determined as secondary outcomes. When compared with high-flux HD, online HDF provided significantly greater percentages of the reduction ratio in plasma cytokine levels, including VEGF (P < 0.001), IL-6 (P = 0.001), IL-8 (P = 0.021), IL-10 (P = 0.011), and tumor necrosis factor-α (P = 0.029). There were no significant differences in intradialytic blood pressures. Online HDF revealed better renal recovery and shorter length of hospitalization than high-flux HD. In conclusion, online HDF in sepsis-related AKI could provide significantly better removal of VEGF and other cytokines and these were associated with better renal outcome than high-flux HD. Thus, online HDF would offer a potential role in hypercytokinemic state in sepsis-related AKI.

• Authors: Wiwat Chancharoenthana, Khajohn Tiranathanagul, Nattachai Srisawat, Paweena Susantitaphong, Asada Leelahavanichkul, Kearkiat Praditpornsilpa, Kriang Tungsanga, Somchai Eiam-Ong
• Journal: Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy (Ther Apher Dial) Vol. 17 Issue 5 Pg. 557-63 (Oct 2013) ISSN: 1744-9987 [Electronic] Australia
• PMID: 24107284 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2013 The Authors. Therapeutic Apheresis and Dialysis © 2013 International Society for Apheresis.

Chemical References

• Cytokines
• Vascular Endothelial Growth Factor A

Topics

• Acute Kidney Injury (etiology, therapy)
• Adult
• Aged
• Cytokines (metabolism)
• Female
• Hemodiafiltration (methods)
• Hospitalization
• Humans
• Length of Stay
• Male
• Middle Aged
• Prospective Studies
• Renal Dialysis (methods)
• Sepsis (complications)
• Treatment Outcome
• Vascular Endothelial Growth Factor A (metabolism)