Effect of Expanded Hemodialysis with Theranova® in Patients with COVID-19.

Autor: Serrano Salazar ML; Nephrology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain., Portolés J; Nephrology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain.; REDInREN 0016/0016/009, Madrid, Spain., de Valdenebro Recio M; Nephrology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain., Rosado Garcia S; Biobank Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Madrid, Spain., Llópez Carratalá MDR; Nephrology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain.; REDInREN 0016/0016/009, Madrid, Spain., Bernabeu-Andreu FA; Biochemistry and Clinical Analyses Department, Hospital Universitario Puerta de Hierro, Madrid, Spain., Sánchez-López AJ; Biobank Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Madrid, Spain., López-Sánchez P; Nephrology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain, registro.gcdp@yahoo.es.
Jazyk: angličtina
Zdroj: Blood purification [Blood Purif] 2022; Vol. 51 (10), pp. 857-865. Date of Electronic Publication: 2022 Jan 11.
DOI: 10.1159/000520891
Abstrakt: Introduction: Cytokine storm control is the main target for improving severe COVID-19 by using immunosuppressive treatment. Effective renal replacement therapy (RRT) could give us an advantage removing cytokines in patients with RRT requirements superimposed on COVID-19.
Methods: This is a prospective observational study in COVID-19 patients who required hemodialysis (HD). Patients were assigned to online hemodiafiltration (OL-HDF) and expanded HD (HDx) according to Brescia group recommendations. We measured several cytokines, β2 microglobulin and albumin levels pre/post-dialysis and on 1st-2nd week. We compared levels among both techniques and control group (HD without COVID-19).
Results: We included 26 patients: 18 with COVID-19 on RRT (5 of them had acute kidney injury [AKI]) and 8 controls. We confirm higher cytokine levels in COVID-19 patients than controls and even higher in patients with AKI than in those with chronic kidney disease. Most cytokines raised during HD session, except IL-10 and TNFα. IL-10 was eliminated by any dialysis technique, while clearance of TNFα was higher in the HDx group. HDx achieved a deeper normalization of cytokines and β2 microglobulin reduction. Mortality was higher in the OL-HDF group than the HDx group.
Discussion: Not all cytokines behave equally along HD session. The following characteristics should be taken into account, such as intrinsic kinetic profile during a HD session. HDx seems to get better performance, probably due to the combination of different factors; however, we did not reach statistical significance due to the small sample size, dropout, and reduction of AKI incidence during the 2nd pandemic wave.
Conclusion: HDx appears to provide better clearance for TNFα and β2 microglobulin during HD session and associates lower mortality. We propose the HDx technique for COVID-19 patients with RRT requirements since it seems to be safe and more effective than OL-HDF. Further studies are still needed, but we hope that our preliminary data may help us in future pandemic waves of SARS-CoV-2 or other viruses still to come.
(© 2022 S. Karger AG, Basel.)
Databáze: MEDLINE
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