Urinary neutrophil gelatinase-associated lipocalin and plasma IL-6 in discontinuation of continuous venovenous hemodiafiltration for severe acute kidney injury: a multicenter prospective observational study

Annals of Intensive Care

Research

Tomoyuki Nakamura¹  Naohide Kuriyama¹  Noriyuki Hattori²  Taka-aki Nakada²  Kent Doi³  Moe Oguchi⁴  Tomohito Sadahiro⁴  Junko Goto⁵  Takeshi Moriguchi⁵  Yohei Komaru⁶  Takashi Shigematsu⁷  Shigeo Negi⁷  Hidetoshi Shiga⁸  Yoshihiko Kikuchi⁸ 

[1] Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Aichi, Japan;Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan;Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, 1138655, Tokyo, Japan;Department of Emergency and Critical Care Medicine, Tokyo Women’s Medical University Yachiyo Medical Center, Chiba, Japan;Department of Emergency and Critical Care Medicine, University of Yamanashi, Faculty of Medicine, Yamanashi, Japan;Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, Tokyo, Japan;Department of Nephrology, Wakayama Medical University, Wakayama, Japan;Emergency and Intensive Care Center, Teikyo University Chiba Medical Center, Chiba, Japan;

关键词: Acute kidney injury;    Continuous venovenous hemodiafiltration;    Discontinuation;    Neutrophil gelatinase-associated lipocalin;    Interleukin 6;   

DOI  :  10.1186/s13613-023-01137-6

 received in 2022-10-17, accepted in 2023-05-05,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundPatients with severe acute kidney injury (AKI) who require continuous venovenous hemodiafiltration (CVVHDF) in intensive care unit (ICU) are at high mortality risk. Little is known about clinical biomarkers for risk prediction, optimal initiation, and optimal discontinuation of CVVHDF.MethodsThis prospective observational study was conducted in seven university-affiliated ICUs. For urinary neutrophil gelatinase-associated lipocalin (NGAL) and plasma IL-6 measurements, samples were collected at initiation, 24 h, 48 h after, and CVVHDF discontinuation in adult patients with severe AKI. The outcomes were deaths during CVVHDF and CVVHDF dependence.ResultsA total number of 133 patients were included. Twenty-eight patients died without CVVHDF discontinuation (CVVHDF nonsurvivors). Urinary NGAL and plasma IL-6 at the CVVHDF initiation were significantly higher in CVVHDF nonsurvivors than in survivors. Among 105 CVVHDF survivors, 70 patients were free from renal replacement therapy (RRT) or death in the next 7 days after discontinuation (success group), whereas 35 patients died or needed RRT again (failure group). Urinary NGAL at CVVHDF discontinuation was significantly lower in the success group (93.8 ng/ml vs. 999 ng/ml, p < 0.01), whereas no significant difference was observed in plasma IL-6 between the groups. Temporal elevations of urinary NGAL levels during the first 48 h since CVVHDF initiation were observed in CVVHDF nonsurvivors and those who failed in CVVHDF discontinuation.ConclusionsUrinary NGAL at CVVHDF initiation and discontinuation was associated with mortality and RRT dependence, respectively. The serial changes of urinary NGAL might also help predict the prognosis of patients with AKI on CVVHDF.Graphical Abstract

【 授权许可】

CC BY   
© The Author(s) 2023

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