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  • 1 Department of Internal Medicine, Medical University, Graz, Austria
  • | 2 Institute of Nuclear Medicine, University Medical Center, Vienna, Austria
  • | 3 Human Nutrition & Metabolism Research and Training Center, Institute of Molecular Biosciences, Karl-Franzens University, Graz, Austria
  • | 4 Department of Nuclear Medicine, Medical University, Graz, Austria
  • | 5 Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University, Graz, Austria
  • | 6 Institute of Physiological Chemistry, Center for Physiological Medicine, Medical University, Graz, Austria
  • | 7 Department of Internal Medicine, Intensive Care Unit, Medical University, Auenbruggerplatz 15, A-8036, Graz, Austria
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Abstract

In this study, we evaluated the impact of intermittent haemodialysis (IHD) on different indices of inflammation [elastase, procalcitonin (PCT) and neopterin]_and on oxidative stress biomarkers [total peroxides (TOC), autoantibodies against oxidized LDL (oLAb), malondialdehyde (MDA)]_in eight mechanically ventilated, critically ill patients with acute oliguric renal failure. IHD decreased the neopterin levels (113 ± 74 vs. 81 ± 46 nmol/L, p = 0.003) in contrast to elastase concentrations, which increased in plasma during this procedure (100 ± 45 vs. 184 ± 73 μg/L, p = 0.002). The membrane passage increased the generation of total peroxides (247 ± 232 vs. 342 ± 253 μmol/L, p = 0.028), whereas PCT, MDA and oLAb were not affected. These results indicate that inflammatory parameters are significantly affected by renal replacement therapy and that membrane passage causes peroxide generation. Therefore, these markers should be interpreted with caution to avoid misinterpretation if used as clinical prognostic markers in critically ill patients undergoing renal replacement therapy.

  • [1]. E. Tonnesen M.-B. Hansen K. Hahndorf et al.1993 Cytokines in plasma and ultrafiltrate during continuous arteriovenous haemofiltration Anaesth. Intens. Care 21 752758.

    • Search Google Scholar
    • Export Citation
  • [2]. R. Bellomo P. Tipping N. Boyce 1993 Continuous venovenous hemofiltration with dialysis removes cytokines from the circulation of septic patients Crit. Care Med. 21 522526.

    • Search Google Scholar
    • Export Citation
  • [3]. S. Andreasson S. Göthberg H. Berggren et al.1993 Hemofiltration modifies complement activation after extracorporeal circulation in infants Ann. Thorac. Surg. 56 15151517.

    • Search Google Scholar
    • Export Citation
  • [4]. R. Bellomo P. Tipping N. Boyce 1995 Interleukin-6 and interleukin-8 extraction during continuous veno-venous hemodiafiltration in septic acute renal failure Ren. Fail. 17 457466.

    • Search Google Scholar
    • Export Citation
  • [5]. J.-N. Hoffman W.-H. Hartl R. Deppisch et al.1995 Hemofiltration in human sepsis: evidence for elimination of immunomodulatory substances Kidney Int. 48 15631570.

    • Search Google Scholar
    • Export Citation
  • [6]. A. Sander W. Armbruster B. Sander et al.1997 Hemofiltration increases IL-6 clearance in early systemic inflammatory response syndrome but does not alter IL-6 and TNFα plasma concentrations Intens. Care Med. 23 878884.

    • Search Google Scholar
    • Export Citation
  • [7]. J.-A. Kellum J.-P. Johnson D. Kramer et al.1998 Diffuse vs convective therapy: effects on mediators of inflammation in patients with severe systemic inflammatory response syndrome Crit. Care Med. 26 19952000.

    • Search Google Scholar
    • Export Citation
  • [8]. A.-S. De Vriese F.-A. Colardyn J.-J. Philippe et al.1999 Cytokine removal during continuous hemofiltration in septic patients J. Am. Soc. Nephrol. 10 846853.

    • Search Google Scholar
    • Export Citation
  • [9]. Y. Wakabayashi Y. Kamijou K. Soma et al.1996 Removal of circulating cytokines by continuous hemofiltration in patients with systemic inflammatory response syndrome of multiple organ dysfunction syndrome Br. J. Surg. 83 393394.

    • Search Google Scholar
    • Export Citation
  • [10]. E.-F. Van Bommel C.-J. Hesse N.-H. Jutte et al.1995 Cytokine kinetics (TNF-alpha, IL-1beta, IL-6) during continuous hemofiltration: a laboratory and clinical study Contrib. Nephrol. 116 6275.

    • Search Google Scholar
    • Export Citation
  • [11]. G. Lonnemann T.-C. Behme B. Lenzner et al.1992 Permeability of dialyzer membranes to TNF alpha-inducing substances derived from water bacteria Kidney Int. 42 6168.

    • Search Google Scholar
    • Export Citation
  • [12]. M. Oberhoffer W. Karzai A. Meier-Hellmann et al.1999 Sensitivity and specificity of various markers of inflammation for the prediction of tumor necrosis factor-alpha and interleukin-6 in patients with sepsis Crit. Care Med. 27 18141818.

    • Search Google Scholar
    • Export Citation
  • [13]. M. Assicot D. Grendel H. Carsin et al.1993 High serum procalcitonin concentration in patients with sepsis and infection Lancet 341 515518.

    • Search Google Scholar
    • Export Citation
  • [14]. E.-J. Giamarellos-Bourboulis P. Grecka G. Poulakou et al.2001 Assessment of procalcitonin as a diagnostic marker of underlying infection in patients with febrile neutropenia Clin. Infect. Dis. 32 17181725.

    • Search Google Scholar
    • Export Citation
  • [15]. E. Ruokonen L. Ilkka M. Niskanen et al.2002 Procalcitonin and neopterin as indicators of infection in critically ill patients Acta Anaesthesiol. Scand. 46 398404.

    • Search Google Scholar
    • Export Citation
  • [16]. M. Meisner K. Tschaikowsky T. Palmaers et al.1999 Comparison of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations at different SOFA scores during the course of sepsis and MODS Crit. Care 3 4555.

    • Search Google Scholar
    • Export Citation
  • [17]. M. Meisner H. Adina J. Schmidt 2006 Correlation of procalcitonin and C-reactive protein to inflammation, complications, and outcome during the intensive care unit course of multiple-trauma patients Crit. Care 10 110.

    • Search Google Scholar
    • Export Citation
  • [18]. W.-L. Lee G.-P. Downey 2001 Leukocyte elastase: physiological functions and role in acute lung injury Am. J. Respir. Crit. Care Med. 164 896904.

    • Search Google Scholar
    • Export Citation
  • [19]. S. Ikei M. Ogawa Y. Yamaguchi 1998 Blood concentrations of polymorphonuclear leucocyte elastase and interleukin-6 indicators for the occurrence of multiple organ failures at the early stage of acute pancreatitis J. Gastro enterol. Hepatol. 13 12741283.

    • Search Google Scholar
    • Export Citation
  • [20]. W.-H. Hörl H.-B. Steinhauer P. Schollmeyer 1985 Plasma levels of granulocyte elastase during haemodialysis: effects of different dialyzer membranes Kidney Int. 28 791796.

    • Search Google Scholar
    • Export Citation
  • [21]. L. Irvine M. Travers K. Simpson et al.1989 Influence of haemodialysis membranes on the release of granulocyte elastase Int. J. Artif. Organs 12 502504.

    • Search Google Scholar
    • Export Citation
  • [22]. M. Haag-Weber W.-H. Hörl 1994 Effect of biocompatible membranes on neutrophil function and metabolism Clin. Nephrol. 42Suppl.1 S31S36.

    • Search Google Scholar
    • Export Citation
  • [23]. H. Wachter D. Fuchs A. Hausen et al.1992 Neopterin: Biochemistry, Methods, Clinical Application De Gruyter Berlin, New York.

  • [24]. W. Strohmaier H. Redl G. Schlag et al.1987 D-erythro-neopterin plasma levels in intensive care patients with and without septic complications Crit. Care Med. 15 757760.

    • Search Google Scholar
    • Export Citation
  • [25]. R. Pacher H. Redl M. Frass et al.1989 Relationship between neopterin and granulocyte elastase plasma levels and the severity of multiple organ failure Crit. Care Med. 17 221226.

    • Search Google Scholar
    • Export Citation
  • [26]. T. Baydar O. Yuksel T.-T. Sahin et al.2009 Neopterin as a prognostic biomarker in intensive care unit patients J. Crit. Care 24 318321.

    • Search Google Scholar
    • Export Citation
  • [27]. A.-R. Rosenkranz E. Templ O. Traindl et al.1994 Reactive oxygen product formation by human neutrophils as an early marker for biocompatibility of dialysis membranes Clin. Exp. Immunol. 98 300305.

    • Search Google Scholar
    • Export Citation
  • [28]. M. Daschner H. Lenhartz D. Botticher et al.1996 Influence of dialysis on plasma lipid peroxidation products and antioxidant levels Kidney Int. 50 12681272.

    • Search Google Scholar
    • Export Citation
  • [29]. F. Tatzber H. Esterbauer 1995 G. Bellomo G. Finardi E. Maggi C. Rice-Evans Free radicals, lipoprotein oxidation and atherosclerosis The Richelieu Press London 245262.

    • Search Google Scholar
    • Export Citation
  • [30]. Esterbauer, H., Gieseg, S., Giessauf, A. et al.: Free radicals and oxidative modification of LDL: role of natural antioxidants. In: Woodford, F. P., Davignon, J., Sniderman, A. (eds): Elsevier Science, 1995, pp. 203208.

    • Search Google Scholar
    • Export Citation
  • [31]. M. Lindschinger K. Nadlinger N. Adelwöhrer et al.2004 Oxidative stress: potential of distinct peroxide determination systems Clin. Chem. Lab. Med. 42 907914.

    • Search Google Scholar
    • Export Citation
  • [32]. U. Resch F. Tatzber A. Budinsky et al.2006 Reduction of oxidative stress and modulation of autoantibodies against modified low-density lipoprotein after rosuvastatin therapy Br. J. Clin. Pharmacol. 61 262274.

    • Search Google Scholar
    • Export Citation
  • [33]. V. Nikolic-Heitzler F. Rabuzin F. Tatzber et al.2006 Persistent oxidative stress after myocardial infarction treated by percutaneous coronary intervention Tohoku J. Exp. Med. 210 247255.

    • Search Google Scholar
    • Export Citation
  • [34]. M. Fukumoto T. Shoji M. Emoto et al.2000 Antibodies against oxidized LDL and carotid artery intima-media thickness in a healthy population Arterioscler. Thromb. Vasc. Biol. 20 703707.

    • Search Google Scholar
    • Export Citation
  • [35]. R. Chiesa G. Melissano R. Castellano et al.1998 In search of biological markers of high-risk carotid artery atherosclerotic plaque: enhanced LDL oxidation Ann. Vasc. Surg. 12 19.

    • Search Google Scholar
    • Export Citation
  • [36]. G.-A. Khoschsorur B.-M. Winklhofer-Roob H. Rabl et al.2000 Evaluation of a sensitive HPLC method for the determination of malondialdehyde, and application of the method to different biological materials Chromatographia 52 181184.

    • Search Google Scholar
    • Export Citation
  • [37]. F. Tatzber S. Griebenow W. Wonisch et al.2003 Dual method for the determination of peroxidase activity and total peroxides — iodide leads to a significant increase of peroxidase activity in human sera Anal. Biochem. 316 147153.

    • Search Google Scholar
    • Export Citation
  • [38]. S. Herget-Rosenthal G. Marggraf F. Pietruck et al.2001 Procalcitonin for accurate detection of infection in haemodialysis Nephrol. Dial. Transplant. 16 975979.

    • Search Google Scholar
    • Export Citation
  • [39]. L. Irvine M. Travers K. Simpson et al.1989 Influence of haemodialysis membranes on the release of granulocyte elastase Int. J. Artif. Organs 12 502504.

    • Search Google Scholar
    • Export Citation
  • [40]. D. Fuchs A. Hausen G. Reibnegger et al.1988 Neopterin levels in long-term hemodialysis Clin. Nephrol. 30 220224.

  • [41]. J. Himmelfarb E. McMonagle E. McMenamin 2000 Plasma protein thiol oxidation and carbonyl formation in chronic renal failure Kidney Int. 58 25712578.

    • Search Google Scholar
    • Export Citation
  • [42]. R.-A. Ward R. Ouseph K.-R. McLeish 2003 Effects of high-flux hemodialysis on oxidant stress Kidney Int. 63 353359.

  • [43]. B. Gonzalez-Diez M. Cavia G. Torres et al.2008 Effect of a hemodiafiltration session with on-line regeneration of the ultrafiltrate on oxidative stress Blood Purif. 26 505510.

    • Search Google Scholar
    • Export Citation
  • [44]. J. Himmelfarb E. McMonagle 2001 Albumin is the major plasma protein target of oxidant stress in uremia Kidney Int. 60 358363.

  • [45]. A. Soejima N. Matsuzawa N. Miyake et al.1999 Hypoalbuminemia accelerates erythrocyte membrane lipid peroxidation in chronic hemodialysis patients Clin. Nephrol. 51 9297.

    • Search Google Scholar
    • Export Citation
  • [46]. L.-A. Calo A. Naso G. Carraro et al.2007 Effect of haemodiafiltration with online regeneration of ultrafiltrate on oxidative stress in dialysis patients Nephrol. Dial. Transplant. 22 14131419.

    • Search Google Scholar
    • Export Citation
  • [47]. J.-M. Roob G. Khoschsorur A. Tiran et al.2000 Vitamin E attenuates oxidative stress induced by intravenous iron in patients on hemodialysis J. Am. Soc. Nephrol. 11 539549.

    • Search Google Scholar
    • Export Citation

Clinical and Experimental Medical Journal
Language English
Size  
Year of
Foundation
2007
Publication
Programme
ceased
Volumes
per Year
 
Issues
per Year
 
Publisher Akadémiai Kiadó
Publisher's
Address
H-1117 Budapest, Hungary 1516 Budapest, PO Box 245
Responsible
Publisher
Chief Executive Officer, Akadémiai Kiadó
ISSN 2060-6249 (Print)
ISSN 2060-968X (Online)

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