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


METHODS
Ten 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).


RESULTS
During 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 microg/kg/min; P < 0.05).


CONCLUSIONS
HD 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.
Mayeur
Nicolas
N
Anesthesia and Intensive Care Unit Department, GRCB 48, Purpan University Hospital, Place du Dr Baylac, TSA 40031, 31059 Toulouse Cedex 9, France. nicolas.mayeur@inserm.fr
Rostaing
Lionel
L
Nogier
Marie B
MB
Jaafar
Acil
A
Cointault
Olivier
O
Kamar
Nassim
N
Conil
Jean M
JM
Fourcade
Olivier
O
Lavayssiere
Laurence
L
D058186:Acute Kidney Injury / Q000209:etiology / Q000628:therapy*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D055316:Cystatin C / Q000097:blood* / Q000493:pharmacokinetics*; D016207:Cytokines / Q000097:blood* / Q000493:pharmacokinetics*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D012772:Shock, Septic / Q000150:complications*
D015415:Biomarkers; D055316:Cystatin C; D016207:Cytokines