Research On The Improvement Of Continuous Renal Replacement Therapy On Endothelial Permeability In Sepsis Induced-Acute Kidney Injury Patients

Objective: To detect the plasma concentration of Angigenin-1 and Syndecan-1 in patients with sepsis induced-acute kidney injury by enzyme-linked immunosorbent assay(ELISA),combined with the variation of clinical indexes,we estimate the improvement of continuous renal replacement therapy(CRRT)on endothelial permeability in sepsis inducedacute kidney Injury patients.Methods :We included patients with sepsis induced-AKI defined by simultaneous presence both of the Kidney Disease: Improving Global Outcomes(KDIGO)criteria for AKI and the consensus criteria for sepsis and by the absence of other clear and established,non–sepsis-related(e.g,radiocontrast,other nephrotoxins)causes of AKI when admitted to the general intensive care unit(ICU)at the Fourth Hospital of Hebei Medical University from December 2015 to December 2016,totally 29 cases.All the patients selected for this study were treated with connection the electrocardiograph monitor,central venous catheter insertion of internal jugular vein or subclavian vein,monitoring heart rate,temperature,central venous pressure(CVP),mean arterial pressure(MAP)and so on.After fully obtaining the consent of the family members,control group were given the sepsis bundle therapy and treatment group were given continuous renal replacement therapy on the basis of control group.The pattern and parameters of continuous renal replacement therapy: Continuous Vena-Venous Hemofiltration(CVVH),predilution rate 90%,therapeutic dose:35ml/kg/h,fluid strategy: the machine zero balance.After enrollment,we gave all the patients low-molecular-weight heparin subcutaneous injection at the time of beginning and 12 th hour.Collect the following indexes at he time of beginning and 12 th hour: lactate,central venous blood oxygen saturation(ScvO2),white blood cell count,procalcitonin,C-reactive Protein,creatinine,and brain natriuretic peptide and fluid intake,urine output and fluid balance during 4 hour and 12 hour.We recorded ventilation days and length of ICU duration.We took the blood samples of all patients within 1 hour of inclusion to the study.After centrifugation at 2000 rpm for 30 min,the supernatant was stored at-80℃.Blood samples were taken to the biochemical laboratory.Results:1 The flow-process and grouping situation of patientsWe screened 40 patients and included 29 patients at last.Among the 40 patients with septic AKI when admitted to ICU,2 patients had contraindications for anticoagulation,2 patients had chronic kidney disease,3patients had diabetes mellitus with unsatisfying blood sugar control,2 patients had hyperkalemia,1patient was unable to get needed datas,1 patient had severe metabolic acidosis.Finally,there were 29 patients enrolled in the study.After fully get the informed consent right of patients members,15 patients were enrolled in the treatment group,14 patients were enrolled in the control group.(see Fig.1)2 The comparison of general condition between the control and treatment groupsPatients are similar in critical condition,the Acute Physiology and Chronic Health Evaluation Scoring System between control and treatment groups are 18.43±4.42 and 20.53±6.90.Sequential Organ Failure Assessment between control and treatment groups are 6.00(3.00)and 7.00(1.00).Acute Physiology and Chronic Health Evaluation Scoring System(P=0.110)and Sequential Organ Failure Assessment(P=0.576)are not statistically significant,so as to the gender(P=0.897),age(P=0.600),height(P=0.529)and weight(P=0.574).(SeeTable 2)3 The concentrations of plasma biomarkers between the control and treatment groupsIn control group,the concentrations of Ang-1(pg/ml)respectively are283.90±144.90,352.26±110.01 and 523.60±141.63,in the treatment group,the concentrations of Ang-1(pg/ml)respectively are 300.79±226.27,430.22±266.88 and 531.30±246.98 at the time of 0h,4th h and 12 th h.Compared with the control group,the concentrations of Ang-1 of treatment group at the time of 4th h and 12 th h are statistically significant,p values are respectively 0.003 and 0.019.In control group,the concentrations of SDC-1(pg/ml)respectively are 5031.02±2863.84,5416.85±3332.89 and 5521.67±3086.21,in the treatment group,the concentrations of SDC-1(pg/ml)respectively are 4667.14±2506.71,4634.45±2700.60 and 4764.96±2498.37.Compared with the control group,the concentration of SDC-1 of treatment group at the time of 0h,4th h and 12 th h are not statistically significant,P values are respectively 0.715,0.531 and0.377,but the concentrations of SDC-1 at the time of 4th h and 12 th h are downtrend.(See Table 3)4 Comparison of the clinical indexes between the control and treatment groupsThe level of lactate,central venous blood oxygen saturation(ScvO2),white blood cell count,procalcitonin,C-reactive Protein,creatinine and brain natriuretic peptide between control and treatment groups are not statistically significant.Ventilation days between control and treatment groups are 2.5(5.00)days and 4.00(2.00)days,and are not statistically significant(P=0.312).Length of ICU duration between control and treatment groups are 8.86±2.54 days and 8.38±1.56 days,and is not statistically significant(P=0.569).In the sepsis induced-acute kidney injury patients,early continuous renal replacement therapy has no effect on declining neither ventilation days,nor the length of ICU duration.(See Table 4)5 Comparison of fluid intake,urine output and fluid balance between the control and treatment groupsDuring 4 hours,fluid intake per weight(ml/kg)between control and treatment groups are 29.61(11.30)and 26.95(6.75),and not statistically significant.(P=0.089).During 12 hours,fluid intake per weight(ml/kg)between control and treatment groups are 43.99(14.95)and 37.23(11.80),and statistically significant(P=0.023).During 12 hours,total fluid intake between control and treatment groups are 2017.00(1294,50)ml and1726.00(1294.50)ml,and statistically significant.(P=0.006).During 4 hours,urine output between control and treatment groups are 120.00(141.25)ml and 70.00(270.00)ml,and not statistically significant(P=0.431).During 12 hours,urine output between control and treatment groups are 480.00(548.50)ml and 278.00(706.00)ml and not statistically significant(P=0.093).During 4 hours,fluid balance(ml)between control and treatment groups are1880.00± 473.00 and 1676.90±228.60,and not statistically significant(P=0.149).During 12 hours,fluid balance(ml)between control and treatment groups are 2498.50±768.50 and 2094.45±581.82 and not statistically significant(P=0.121).(See Table 5、Table 6)Conclusions:1 From the variations of plasma biomarkers,we conclude that the continuous renal replacement therapy can improve the endothelial permeability in septic acute kidney patients.2 In the epsis induced-AKI patients,early continuous renal replacement therapy could have a good effect on optimizing volume management.3 In the sepsis induced-acute kidney injury patients,early continuous renal replacement therapy has no effect on neither ventilation days,nor the length of ICU duration.