Effects of continuous renal replacement therapy on renal inflammatory cytokines during extracorporeal membrane oxygenation in a porcine model

Hu Yimin, Yu Wenkui, Shi Jialiang, Chen Qiyi, Shen Juanhong, Lin Zhiliang, He Changsheng, Li Ning, Li Jieshou, Hu Yimin, Yu Wenkui, Shi Jialiang, Chen Qiyi, Shen Juanhong, Lin Zhiliang, He Changsheng, Li Ning, Li Jieshou

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) has been recommended for the treatment of patients with acute, potentially reversible, life-threatening respiratory failure which unresponsive to conventional therapy. But it is unclear about how ECMO affects renal tissue.

Methods: Twenty-four piglets weighing 25 to 32 kg were used in this experiment. The piglets were randomly allocated to 4 groups of 6 animals each: sham group (S group), control group (C group), VV-ECMO group (E group), VV-ECMO combined with CRRT group (EC group). The piglets were sacrificed and the kidney tissue were harvest to determine the levels of IL-1β, IL-6, TNF-α and NF-КB by using the ELISA and RT-PCR method, respectively.

Results: Compared with C group and S group, E group renal tissue IL-1β, IL-6, TNF-α and NF-КB expression increased significantly, respectively (p < 0.01). Compared with E group, EC group showed renal tissue IL-1β, IL-6, TNF-α and NF-КB expression decreased significantly, respectively (p < 0.05).

Conclusion: ECMO enables to inflammatory cytokines including IL-1β, IL-6, TNFα, NF-КB released significantly, renal function impaired and immune homeostasis were to imbalance; ECMO combined with CRRT treatment can alleviate levels of inflammatory cytokines, maintain immune homeostasis balance and thus ameliorate the ECMO-related acute kidney injury(AKI).

Figures

Figure 1
Figure 1
Renal IL-1β expression in all groups.
Figure 2
Figure 2
Renal IL-6 expression in all groups.
Figure 3
Figure 3
Renal TNF-α expression in all groups.
Figure 4
Figure 4
Renal NF-КB expression in all groups.

References

    1. Davies A, Jones D, Bailey M. Extracorporeal membrane oxygenation for 2009 influenza a(H1N1) acute respiratory distress syndrome[J] JAMA. 2009;302:1888–1895.
    1. Kumar A, Zarychanski R, Pinto R. Critically ill patients with 2009 influenza a(H1N1) infection in canada[J] JAMA. 2009;302:1872–1879. doi: 10.1001/jama.2009.1496.
    1. Chalwin RP, Moran JL, Graham PL. The role of extracorporeal membrane oxygenation for treatment of the adult respiratory distress syndrome: Review and quantitative analysis. Anaesth[J] Intensive Care. 2008;36:152–161.
    1. Doll N, Kiaii B, Borger M. Five-year results of 219 consecutive patients treated with extracorporeal membrane oxygenation for refractory postoperative cardiogenic shock[J] Ann Thorac Surg. 2004;77:151–157. doi: 10.1016/S0003-4975(03)01329-8.
    1. Smedira NG, Moazami N, Golding CM. Clinical experience with 202 adults receiving extracorporeal membrane oxygenation for cardiac failure: survival at five years[J] J Thorac Cardiovasc Surg. 2001;122:92–102. doi: 10.1067/mtc.2001.114351.
    1. Conrad SA, Rycus PT, Dalton H. Extracorporeal life support registry report 2004[J] ASAIO J. 2005;51:4–10. doi: 10.1097/01.MAT.0000151922.67540.E9.
    1. Sell LL, Cullen ML, Whittlesey GC. Experience with renal-failure during extracorporeal membrane oxygenation treatment with continuous hemofiltration[J] J Pediatr Surg. 1987;2:600–602.
    1. Gbadegesin R, Zhao S, Charpie J. Significance of hemolysis on extracorporeal life support after cardiac surgery in children[J] Pediatr Nephrol. 2009;24:589–595. doi: 10.1007/s00467-008-1047-z.
    1. Kelly RE, Phillips JD, Foglia RP. Pulmonary edema and fluid mobilization as determinants of the duration of ecmo support[J] J Pediatr Surg. 1991;26:1016–1022. doi: 10.1016/0022-3468(91)90665-G.
    1. Van Bommel E, Bouvy ND, So KL. A cute dialytic support for the critically ill: intermittent hemodialysis versus continuous arteriovenous hemodiafilltration[J] Am J Nephrol. 1995;15:192. doi: 10.1159/000168832.
    1. Leblanc M, Garred LJ, Cardinal J. Catabolism in critical illness: estimation from urea nitrogen appearance and creatinine production during continuous renal rep lacement therapy[J] Am J Kidney Dis. 1998;32:444. doi: 10.1053/ajkd.1998.v32.pm9740161.
    1. Lonnemann G, Bechstein M, Linnenweber S. Tumornecrosis factor alpha during continuous highflux hemodialysis in sepsis with acute renal failure[J] Kidney Int Suppl. 1999;72:S84.
    1. Peng Y, Yuan Z, Li H. Removal of inflammatory cytokines and endotoxin by venovenous continuous renal replacement therapy for burned patients with sepsis[J] Burns. 2005;31:623. doi: 10.1016/j.burns.2005.02.004.
    1. Beckmann A, Benk C, Beyersdorf F. Position article for the use of extracorporeal life support in adult patients[J] Euro J of Cardio-th Surg. 2011;40:676–681.
    1. Heilmann C, Trummer G, Berchtold-Herz M. Established markers of renal and hepatic failure are not appropriate to predict mortality in the acute stage before extracorporeal life support implantation[J] Euro J Cardio-th Surg. 2012;1:1–7.
    1. Alan MG, Stephen MW, Michael JG. Extracorporeal life support[J] BMJ. 2010;341:982–986.
    1. Britt ML, Joseph T, Ashish RK. Plasma concentrations of inflammatory cytokines rise rapidly during ECMO-related SIRS due to the release of pre-formed stores in the intestine[J] Lab Invest. 2010;90:128–139. doi: 10.1038/labinvest.2009.119.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi