scholarly journals Removal of Procalcitonin and Selected Cytokines during Continuous Veno-Venous Hemodialysis Using High Cutoff Hemofilters in Patients with Sepsis and Acute Kidney Injury

2018 ◽  
Vol 46 (2) ◽  
pp. 153-159 ◽  
Author(s):  
Grzegorz Kade ◽  
Sławomir Literacki ◽  
Agnieszka Rzeszotarska ◽  
Stanisław Niemczyk ◽  
Arkadiusz Lubas
Keyword(s):  
Septic Shock ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Interleukin 12 ◽  
Interleukin 17 ◽  
Reactive Protein ◽  
Before And After ◽  
Factor Α ◽  
The Impact ◽  
Necrosis Factor

Introduction: The purpose of this study was to evaluate the impact of continuous veno-venous hemodialysis (CVVHD) using high cutoff (HCO) hemofilters on the removal of procalcitonin (PCT), and other inflammatory markers in the treatment of patients during septic shock with acute kidney injury (AKI). Materials and Methods: Thirty-six patients with septic shock and AKI were included in the study. Before and after the 24-h HCO-CVVHD, PCT, native C-reactive protein (CRP) and cytokines (interleukin-1β, interleukin-6, interleukin-12, interleukin-17, tumor necrosis factor-α) in serum and effluent were assessed. Results: After the HCO-CVVHD serum concentrations of PCT, CRP and selected cytokines were significantly lower. The decrease in PCT was bigger than in CRP (p = 0.007). The change in PCT concentration was significantly influenced by PCT and IL-17 clearances (R2 = 0.525; p < 0.001). Conclusion: In contrast to the native CRP, monitoring of PCT during HCO-CVVHD is less useful because it reflects the clearance of this marker and anti-inflammatory effectiveness of the method.

Systemic over-release of interleukin-17 in acute kidney injury after septic shock: Clinical and experimental evidence

2016 ◽  
Vol 178 ◽  
pp. 68-76 ◽  
Author(s):  
Panagiota Maravitsa ◽  
Maria Adamopoulou ◽  
Aikaterini Pistiki ◽  
Mihai G. Netea ◽  
Konstantinos Louis ◽  
...  
Keyword(s):  
Septic Shock ◽  
Acute Kidney Injury ◽  
Experimental Evidence ◽  
Kidney Injury ◽  
Interleukin 17

The Effect of Intra-Dialytic Exercise on Inflammation and Blood Endotoxin Levels

2017 ◽  
Vol 44 (1) ◽  
pp. 51-59 ◽  
Author(s):  
Jonathan Wong ◽  
Philip Davis ◽  
Ashish Patidar ◽  
Yonglong Zhang ◽  
Enric Vilar ◽  
...  
Keyword(s):  
High Sensitivity ◽  
Acute Effect ◽  
Tumour Necrosis Factor Α ◽  
Healthy Individuals ◽  
C Reactive Protein ◽  
Intense Exercise ◽  
Reactive Protein ◽  
Before And After ◽  
Factor Α ◽  
Necrosis Factor

Background: In healthy individuals, an acute inflammatory response occurs after intense exercise due to gut ischaemia and intestinal bacterial endotoxin translocation into the bloodstream. This process maybe exacerbated in patients who exercise during dialysis due to large volume shifts experienced by many during haemodialysis (HD). The acute effect of intra-dialytic exercise on blood endotoxins and inflammation is not known. Method: The effect of intra-dialytic exercise on blood endotoxin and inflammation was investigated in 10 patients and compared with resting haemodialysis. Blood was measured for endotoxin and inflammatory biomarkers before and after dialysis. Result: With the exception of one sample, all samples tested negative for endotoxin. Intra-dialytic exercise attenuated the rise of interleukin-6, tumour necrosis factor-α and high-sensitivity C-reactive protein after the HD procedure. Conclusion: Intra-dialytic exercise was not associated with an observable rise in blood endotoxin, although it may ameliorate the inflammatory effects of the HD procedure. Larger studies are needed to confirm this finding.

Challenges Associated with Managing a Multicenter Clinical Trial in Severe Burns

2020 ◽  
Vol 41 (3) ◽  
pp. 681-689
Author(s):  
Elsa C Coates ◽  
Elizabeth A Mann-Salinas ◽  
Nicole W Caldwell ◽  
Kevin K Chung
Keyword(s):  
Septic Shock ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
High Volume ◽  
The United States ◽  
Data Safety Monitoring Board ◽  
Institutional Review Boards ◽  
Severe Burns ◽  
High Volume Hemofiltration ◽  
The Impact

Abstract Managing multicenter clinical trials (MCTs) is demanding and complex. The Randomized controlled Evaluation of high-volume hemofiltration in adult burn patients with Septic shoCk and acUte kidnEy injury (RESCUE) trial was a prospective, MCT involving the impact of high-volume hemofiltration continuous renal replacement therapy on patients experiencing acute kidney injury and septic shock. Ten clinical burn centers from across the United States were recruited to enroll a target sample size of 120 subjects. This manuscripts reviews some of the obstacles and knowledge gained while coordinating the RESCUE trial. The first subject was enrolled in February 2012, 22 months after initial IRB approval and 29 months from the time the grant was awarded. The RESCUE team consisted of personnel at each site, including the lead site, a data coordination center, data safety monitoring board, steering committees, and the sponsor. Seven clinical sites had enrolled 37 subjects when enrollment stopped in February 2016. Obstacles included changes in institutional review boards, multiple layers of review, staffing changes, creation and amendment of study documents and procedures, and finalization of contracts. Successful completion of a MCT requires a highly functional research team with sufficient patient population, expertise, and research infrastructure. Additionally, realistic timelines must be established with strategies to overcome challenges. Inevitable obstacles should be discussed in the pretrial phase and continuous correspondence must be maintained with all relevant research parties throughout all phases of study.

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