Removal of inflammatory mediators by hemodiafiltration in patients with acute renal failure

• Grant number: 05/02524-0
• Support Opportunities: Scholarships in Brazil - Post-Doctoral
• Start date: November 01, 2005
• End date: June 30, 2009
• Field of knowledge: Health Sciences - Medicine
• Principal Investigator: Miguel Cendoroglo Neto
• Grantee: Beata Marie Redublo Quinto
• Host Institution: Escola Paulista de Medicina (EPM). Universidade Federal de São Paulo (UNIFESP). Campus São Paulo. São Paulo , SP, Brazil
• Associated research grant: 04/08311-6 - Molecular, cellular and pathophysiological mechanisms on acute renal failure, AP.TEM

Abstract

More than 9% of intern patients eventually develop acute renal failure (ARF), although only a small portion actually require renal reposition therapy. The most of patients who develop isolated ARF are treated with intermittent hemodialysis (IHD). Patients in intensive care units (ICU) with severe clinical complications, such as recovering from surgery or traumas, with multiple organs failure and systems often come to develop ARF. In these severe patients ARF is a clinical manifestation commonly related to sepsis. Nephrology continues challenged to develop an adequate methodology for treating these patients banned to dialysis. ARF has devastating effects, where statistics reveal mortality ranging between 42-75% for most groups. The dialysis therapies at this present moment include IHD, peritoneal dialysis or therapies of continuos renal reposition (TCRR). TCRR shows advantages when compared to IHD, including better homeostasis, hemodynamics and a more efficient volume control. TCRR also allows virtually unlimited liquid infusion as parenteral nutrition and vasoactive drugs, allowing an adequate clearance of solutes. There are, though, some disadvantages, such as, high cost, need for parallel use of anti coagulants and patient immobilization during long periods, increasing with this, the risk of bleeding and nasocomial infection. In clinical practice branches of TCRR are commonly used. These methods involve rollers pumps, where the access to the veins is simple inflicting few complications. Various studies have attempt to demonstrate the beneficial effects of TCRR in severe patients, whether due to the convective, diffuse or adsorptive removal of pro inflammatory cytokine, in particular TNF-alpha and IL-1. The information in the literature on the matter of cytokine removal through TCRR in patients with ARF associated with sepsis is naive and conflicting.This study involves 60 patients with ARF in TCRR and 30 healthy voluntaries (control group). These results intend to increase our understanding about the kinetics of the inflammatory mediators during hemofiltration treatments. With this understanding potential development of new methods for increasing the eficiency of hemofiltration is possible, reducing the mononuclear cells (MN) and neutrophils dysfunction, hence improving the first line of defense in severe patients with ARF.