Clearance of NT-proBNP and Procalcitonin during Continuous Venovenous Hemodialysis with the Medium Cutoff Filter in Patients with Rhabdomyolysis-Associated Early Acute Kidney Injury

Abstract

<b><i>Introduction:</i></b> In polytrauma patients with AKI continuous venovenous hemodialysis (CVVHD) with medium cutoff membrane filters is commonly adopted to increase the removal of both myoglobin and inflammatory mediators, but its impact on increasing molecular weight markers of inflammation and cardiac damage is debated. <b><i>Methods:</i></b> Twelve critically ill patients with rhabdomyolysis (4 burns and 8 polytrauma patients) and early AKI requiring CVVHD with EMIc2 filter were tested for 72 h on serum and effluent levels for NT-proBNP, procalcitonin (PCT), myoglobin, C-reactive protein (CRP), alpha1-glycoprotein, albumin, and total protein. <b><i>Results:</i></b> The sieving coefficients (SCs) for proBNP and myoglobin were as higher as 0.5 at the start, decreased to 0.3 at the 2nd h, and then slowly declined to the final value of 0.25 and 0.20 at the 72nd h, respectively. PCT showed a negligible SC at the 1st h, a peak of 0.4 at the 12th h, and a final value of 0.3. SCs for albumin, alpha1-glycoprotein, and total protein were negligible. A similar trend was observed for the clearances (17–25 mL/min for proBNP and myoglobin; 12 mL/for PCT; <2 mL/min for albumin, alpha1-glycoprotein, and total protein). No correlation was found between systemic determinations and filter clearances of proBNP, PCT, and myoglobin. Net fluid loss/hour during CVVHD positively correlated with systemic myoglobin for all patients and NT-proBNP in the burn patients. <b><i>Conclusion:</i></b> CVVHD with EMiC2 filter showed low clearances for NT-proBNP and procalcitonin. CVVHD did not significantly affect the serum levels of these biomarkers, which could be adopted in the clinical management of early CVVHD patients.

Safety and Metabolic Tolerance of Citrate Anticoagulation in Critically Ill Polytrauma Patients with Acute Kidney Injury Requiring an Early Continuous Kidney Replacement Therapy

“…As a result, we experienced both a high number of hemorrhagic episodes and premature circuit clotting. In effect, in agreement with previous reports [ 8 , 26 , 27 ], we observed that the safety of the treatment was significantly increased with citrate, as documented by a significant reduction in hemorrhagic complications and an increased daily hour of effective dialysis.…”

“…CKRT was performed according to the manufacturer’s instructions with high permeability biocompatible synthetic dialysis membranes (polyacrylonitrile or polysulfone dialyzers). For the patients with documented rhabdomyolysis requiring CKRT, from 2011 our protocol envisaged the use of a medium cut-off polysulfone filter EMiC2 (Fresenius Medical Care) to increase the myoglobin loss in the effluent [ 27 ]. Blood flow and effluent rates were set according to the target of dialysis adequacy, accomplishing the dialysis target of 20–25 mL/kg/h [ 25 ].…”

Kidney replacement and conservative therapies in rhabdomyolysis: a retrospective analysis

“…Data from our research group already showed a better myoglobin clearance in patients treated with CVVHD-HCO compared to CVVHDF (mean difference of 5.5 (4–7) ml/min, p < 0.0005; (12.3 vs. 3.7 ml/min)) [ 12 ]. Another investigation could verify a relevant myoglobin elimination in CVVHD-HCO in rhabdomyolysis, too [ 48 ]. In a recently published study CVVHD-HCO combined with an adsorber had a particularly good elimination capacity [ 21 ].…”

“…Extracorporeal treatment can not recommended in patients with working kidneys [43] as it provides the highest elimination capacity of myoglobin. If KRT is necessary, various modalities of KRT with different myoglobin elimination capacity are available [9,11,12,14,15,17,21,32,[46][47][48], but good clinical data concerning outcome of patients are missing. Therefore, no recommendation for any specific method of KRT is available until now [43].…”

“…3 Risk for all-cause hospital mortality with the various kidney replacement modalities. CVVH continuous veno-venous hemofiltration, CVVHD-HCO continuous veno-venous hemodialysis with high cut-off filter, CVVHD-adsorber continuous veno-venous hemodialysis with "standard" high-flux filter and adsorber, CVVHDF continuous veno-venous hemodiafiltration, CVVHD continuous veno-venous hemodialysis, SLEDD sustained low efficiency daily dialysis investigation could verify a relevant myoglobin elimination in CVVHD-HCO in rhabdomyolysis, too [48]. In a recently published study CVVHD-HCO combined with an adsorber had a particularly good elimination capacity [21].…”