High Cut-Off Hemofiltration versus Standard Hemofiltration: A Pilot Assessment of Effects on Indices of ApoptosisAtan R.a · Virzi G.M.b, c · Peck L.d · Ramadas A.a · Brocca Ab, c · Eastwood G.d · Sood S.a · Ronco C.b, c · Bellomo R.d, e · Goehl H.f · Storr M.f
aClinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Malaysia; bDepartment of Nephrology, Dialysis and Transplant, San Bortolo Hospital, San Bortolo, and cInternational Renal Research Institute Vicenza, IRRIV, Vicenza, Italy; dDepartment of Intensive Care, Austin Hospital, Heidelberg, Vic., and eAustralian and New Zealand Intensive Care Research Centre, Melbourne, Vic., Australia; fGambro Dialysatoren GmbH, Research and Development, Hechingen, Germany
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Objectives: To measure plasma pro-apoptotic and pro-necrotic activity in severe acute kidney injury (AKI) patients within a randomized controlled trial of continuous veno-venous hemofiltration with high cut-off filters (CVVH-HCO) versus standard filters (CVVH-Std). Methods: We measured pro-apoptotic and pro-necrotic plasma activity by trypan blue exclusion cell viability assay, detection of DNA fragmentation, and by determination of caspase-3 activity and annexin V-based apoptosis and necrosis detection assay. Results: Compared to no apoptosis or necrosis after incubation with healthy plasma, 14-18% of cells showed apoptosis and 4-8% showed necrosis after incubation with plasma from AKI patients. When comparing different measures of pro-apoptotic or pro-necrotic activity, CVVH-HCO and CVVH-Std showed no differential effects on such activity, which remained high over the first 3 days of treatment. However, using annexin V-FITC, there was a significant drop in pro-apoptotic activity across the filter for the CVVH-HCO group (p = 0.043) but not for the CVVH-Std group (p = 0.327) and a significant difference between the two groups (CVVH-HCO vs. CVVH-Std p = 0.006). Conclusions: Patients with severe AKI have increased pro-apoptotic and pro-necrotic activity. Although on single-pass effect assessment, CVVH-HCO was superior to CVVH-Std in decreasing annexin V-FITC-assessed pro-apoptotic activity, there was no overall attenuation of such activity during the first 3 days of treatment.
© 2014 S. Karger AG, Basel
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