title: Effect of anticoagulation regimens on handling of interleukin-6 and -8 during continuous venovenous hemofiltration in critically ill patients with acute kidney injury.
abstract: OBJECTIVE
  During continuous venovenous hemofiltration (CVVH) to replace renal function in acute kidney injury (AKI), anticoagulation of the filter is routinely required. A survival benefit for citrate has been reported, possibly due to reduced proinflammatory effects of the filter (bioincompatibility). We hypothesized that the type of anticoagulation modulates the immune response to, and clearance by CVVH of interleukin-6 (IL-6) and -8 (IL-8).
  
  
  METHODS
  Three anticoagulation regimens were compared: trisodium citrate (n=17), unfractionated heparin (n=8) and no anticoagulation in case of bleeding tendency (n=13). Immediately before initiation of CVVH (cellulose triacetate membrane) pre-filter blood was drawn. Thereafter, at 10, 60, 180 and 720 min, samples were collected from the pre- and postfilter blood and from ultrafiltrate. IL-6 and IL-8 were determined by ELISA.
  
  
  RESULTS
  High inlet levels of IL-6 and IL-8, particularly in the no anticoagulation group, were associated with non-survival. The inlet concentrations and mass rates of IL-6 and IL-8 decreased during CVVH. The course of fluxes across the filter were similar for the groups, however. Although increasing in time for IL-6 in the no anticoagulation group, mass removal and adsorption of IL-6 and IL-8 were low and did not differ among the anticoagulation groups.
  
  
  CONCLUSIONS
  Blood to membrane contact, adsorption/clearance and anticoagulation do not increase nor attenuate high circulating levels of IL-6 and IL-8 during CVVH for AKI. This renders the hypothesis that the reported survival benefit for citrate anticoagulation is based on a reduction of bioincompatibility unlikely.
authors.affiliation: Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands. louiseschilder@hotmail.com
authors.forename: Louise
authors.initials: L
authors.lastname: Schilder
authors.forename: S Azam
authors.initials: SA
authors.lastname: Nurmohamed
authors.forename: Pieter M
authors.initials: PM
authors.lastname: ter Wee
authors.forename: Armand R J
authors.initials: AR
authors.lastname: Girbes
authors.forename: Albertus
authors.initials: A
authors.lastname: Beishuizen
authors.forename: Nanne J
authors.initials: NJ
authors.lastname: Paauw
authors.forename: Robert H J
authors.initials: RH
authors.lastname: Beelen
authors.forename: A B Johan
authors.initials: AB
authors.lastname: Groeneveld
mesh_terms: D058186:Acute Kidney Injury / Q000378:metabolism / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D002951:Citrates / Q000627:therapeutic use; D005260:Female; D006440:Hemofiltration; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D016209:Interleukin-8 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D002951:Citrates; D015850:Interleukin-6; D016209:Interleukin-8; C514290:trisodium citrate; D006493:Heparin