Microcirculatory alterations during continuous renal replacement therapy in ICU: A novel view on the ‘dialysis trauma’ concept

Pipili, Chrysoula; Vasileiadis, Ioannis; Grapsa, Eirini; Tripodaki, Elli-Sophia; Ioannidou, Sophia; Papastylianou, Androula; Kokkoris, Stelios; Routsi, Christina; Politou, Marianna; Nanas, Serafeim

doi:10.1016/j.mvr.2015.09.004

Cited by 8 publications

(9 citation statements)

References 28 publications

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“…Deterioration of the microcirculation during the first 24 hours of CRRT has been reported. ( 5 ) However, that study was based on a comparatively smaller number of variables. Drop in minimum SatO 2 values during the experimental period was the only significant change in this study.…”

Section: Discussionmentioning

confidence: 96%

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Near-infrared spectroscopy parameters in patients undergoing continuous venovenous hemodiafiltration

Chaves

Tafner

Chen

et al. 2019

Einstein (São Paulo)

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Objective To investigate the impacts of continuous venovenous hemodiafiltration on the microcirculation in patients with acute kidney injury.Methods A prospective observational pilot study conducted in a 40-bed, open clinical-surgical intensive care unit of a private tertiary care hospital located in the city of São Paulo (SP), Brazil. Microcirculation was assessed using near-infrared spectroscopy by means of a 15mm probe placed over the thenar eminence. Vascular occlusion test was performed on the forearm to be submitted to near-infrared spectroscopy by inflation of a sphygmomanometer cuff to 30mmHg higher than the systolic arterial pressure. The primary endpoint was the assessment of near-infrared spectroscopy-derived parameters immediately before, 1, 4 and 24 hours after the initiation of continuous venovenous hemodiafiltration.Results Nine patients were included in this pilot study over a period of 2 months. Minimum tissue oxygen saturation measured during the vascular occlusion test was the only near-infrared spectroscopy-derived parameter to differed over the time (decrease compared to baseline values up to 24 hours after initiation of continuous venovenous hemodiafiltration).Conclusion The impacts of microcirculatory dysfunction on clinical outcomes of patients undergoing to continuous venovenous hemodiafiltration need to be further investigated.

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Section: Discussionmentioning

confidence: 96%

“…Still, only one study assessing microcirculatory changes associated with RRT in patients with AKI has been published to date. ( 5 )…”

Section: Introductionmentioning

confidence: 99%

Near-infrared spectroscopy parameters in patients undergoing continuous venovenous hemodiafiltration

Chaves

Tafner

Chen

et al. 2019

Einstein (São Paulo)

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“…NIRS operates by the same principle as pulse oximetry with the difference that while the former measures only oxyhaemoglobin, NIRS measures the difference between oxyhaemoglobin and deoxygenated haemoglobin [38]. Recently, this method was applied in intensive care unit patients with acute renal failure [39], but to the best of our knowledge not yet in the haemodynamic monitoring of chronic HD patients. A recent study used an older tool, transcutaneous pO 2 (TcpO 2 ) monitoring, in the assessment of changes in tissue perfusion in the lower limb.…”

Section: Changes In Perfusion Are Important But How Can They Be Measmentioning

confidence: 99%

Novel Insights into the Pathogenesis and Prevention of Intradialytic Hypotension

et al. 2018

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Background: Intradialytic hypotension (IDH) is a common complication of haemodialysis (HD) and associated with adverse outcomes, especially when a nadir definition (systolic blood pressure <90 mm Hg) is used. The pathogenesis of IDH is directly linked to the discontinuous nature of the HD treatment, in combination with patient-related factors such as age, diabetes mellitus and cardiac failure. Summary: Although the decline in blood volume due to removal of fluid by ultrafiltration is the prime mover, thermally induced reflex vasodilation compromises the haemodynamic response to hypovolemia. Recent studies have stressed the relevance of changes in tissue perfusion during HD, which may translate in long-term organ damage. Monitoring changes in tissue perfusion, for which emerging evidence becomes available, appears to have great promise in the fine-tuning of the dialysis procedure. Key Messages: While it is unlikely that IDH can be completely prevented, reduction in inter-dialytic weight gain, prevention of an increase in core temperature by adjusting the dialysate temperature and more frequent or prolonged dialysis treatment remain cornerstones in providing a more comfortable and safe treatment.

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“…Thus, CRRT-induced changes in the levels of cytokines may not be sufficient to influence clinical endpoints. Moreover, in recent years, a new concept termed “dialysis trauma” suggests that dialysis involves microcirculation (24). Our findings suggest that elimination of DAMPs worsened the outcome in AKI patients with sepsis undergoing CVVH.…”

Section: Discussionmentioning

confidence: 99%

Effects of Changes in the Levels of Damage-Associated Molecular Patterns Following Continuous Veno–Venous Hemofiltration Therapy on Outcomes in Acute Kidney Injury Patients With Sepsis

Wu¹,

Ren²,

Liu³

et al. 2019

Front. Immunol.

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Background: We investigated the association of damage-associated molecular pattern (DAMP) removal with mortality in sepsis patients undergoing continuous veno–venous hemofiltration (CVVH).Methods: Circulating levels of DAMPs [mitochondrial DNA (mtDNA); nuclear DNA (nDNA); heat shock protein 70 (HSP70); and high mobility group box 1 (HMGB1)] and cytokines were measured at baseline, 6 and 12 h after initiation of CVVH. Urinary DNA levels were analyzed at baseline and end of CVVH. The expression of human leukocyte antigen (HLA)-DR was assayed at 0, 3, and 7 days after initiation of CVVH. Moreover, the effects of HSP70 and HMGB1 clearance on survival were analyzed.Results: We evaluated 43 patients with acute kidney injury (AKI) (33 sepsis patients). Twenty-two sepsis patients (67%) and three non-sepsis patients (30%) expired (P = 0.046). Significant reductions in the levels of circulating interleukin-6 (P = 0.046) and tumor necrosis factor-α (P = 0.008) were found in the sepsis group. The levels of mtDNA were increased (ND2, P = 0.035; D-loop, P = 0.003), whereas that of HSP70 was reduced (P = 0.000) in all patients during the first 12 h. The levels of DAMPs in the plasma were markedly increased after blood passage from the inlet through the dialyzer in survivor sepsis patients. The clearance rates of HSP70 and HMGB1 were good predictors of mortality [area under the curve (AUC) = 0.937, P = 0.000; AUC = 0.90, P = 0.001, respectively]. The level of HLA-DR was increased in response to higher HSP70 clearance (P = 0.006). Survival was significantly worse in groups with higher clearance rates of HSP70 and HMGB1 than the cut-off value (log-rank test: P = 0.000 for both). Higher HSP70 clearance was a significant independent predictor of mortality (odds ratio = 1.025, 95% confidence interval [CI]: 1.012–1.039, P = 0.000). The urinary nDNA (β-globin) level before CVVH was an independent risk factor for the duration of CVVH in patients with sepsis (sRE = 0.460, 95% CI: 1.720–8.857, P = 0.005).Conclusion: CVVH removes inflammatory factors, reduces urinary DAMPs, and removes plasma DAMPs. However, survival decreases in response to higher HSP70 clearance.

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Microcirculatory alterations during continuous renal replacement therapy in ICU: A novel view on the ‘dialysis trauma’ concept

Cited by 8 publications

References 28 publications

Near-infrared spectroscopy parameters in patients undergoing continuous venovenous hemodiafiltration

Near-infrared spectroscopy parameters in patients undergoing continuous venovenous hemodiafiltration

Novel Insights into the Pathogenesis and Prevention of Intradialytic Hypotension

Effects of Changes in the Levels of Damage-Associated Molecular Patterns Following Continuous Veno–Venous Hemofiltration Therapy on Outcomes in Acute Kidney Injury Patients With Sepsis

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