Acute Kidney Injury, Sepsis
Conditions
Brief summary
Following the concept of peak concentration hypothesis, which suggest the cutting peak of pro- and anti-inflammatory mediators would result in restoring a situation of immunohomeostasis. The investigators conducted the prospective randomized controlled trial aimed to compare the clearance efficacy between on-line hemodiafiltration and high-flux hemodialysis in sepsis-related acute kidney injury patients. The lowering cytokines level during sepsis is postulated to improved outcomes in sepsis.
Detailed description
1. Blood samples were taken from patients before and at the end of 4-hour in the first dialysis session. The percentage of reductions were calculated from the before and ending samples. The values of postfilter samples were corrected for changes in plasma volume, based on hemoglobin (Hb) of prefilter. 2. VEGF and other cytokines (IL-6, IL-8, IL-10, and TNF-α) were determined in the plasma separated from EDTA blood. After collection, plasma separation was achieved by centrifugation for 10 min at 1,500 g. Immediately after separation, the samples were stored at -70 ºC until further analysis. 3. All determinations were carried out in duplicate. The panels of cytokines (VEGF, IL-6, IL-8, IL-10, and TNF-α) were measured using the Luminex xMap-based multiplex technology. Assays were performed using the MILLIPLEX MAP (multi-analyte panels) 5-plex Cytokine Kit (Millipore, Billerica, MA) on the Luminex® instrument according to the manufacturer's procedure.
Interventions
PROCEDUREOn-line hemodiafiltration
pre-dilution 40% of blood flow rate blood flow rate 300-350 ml/min dialysate flow rate 800 ml/min
PROCEDUREHigh-flux Hemodialysis
blood flow rate 300-350 ml/min dialysate flow rate 800 ml/min
Sponsors
Chulalongkorn University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Sepsis * acute kidney injury (RIFLE classification F) * Age more than 18
Exclusion criteria
* Hemodynamic instability * Whom written informed consent could not be obtained
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Reduction in plasma Vascular Endothelial Growth Factor (VEGF)level | At time 0-hour and 4-hour of the study dialysis session |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Intradialytic hypotension | During 4 hours of the study dialysis session | — |
| Renal recovery (at 30 days) | participants will be followed for the renal recovery (dialysis-free) for the 30 days from the first initiation of dialysis | — |
| Hospital patient mortality | participants will be followed for the duration of hospital stay (an expected average of 5 weeks) | mortality during hospital admission |
Countries
Thailand
Outcome results
None listed