Related Experiment Videos
Haemostatic changes in systemic inflammatory response syndrome during continuous renal replacement therapy
N García-Fernández1, F J Lavilla, E Rocha
1Dept. of Nephrology, University Clinic of Navarra, School of Medicine, University of Navarra, Pamplona, Spain.
Journal of Nephrology
|August 18, 2000
Summary
Continuous Renal Replacement Therapy (CRRT) in Systemic Inflammatory Response Syndrome (SIRS) patients may decrease plasminogen activity inhibitor type 1 (PAI-1), potentially improving outcomes. No significant differences were found between continuous venovenous hemofiltration (CVVH) and hemodiafiltration (CVVHDF) methods.
Area of Science:
- Critical Care Medicine
- Nephrology
- Hematology
Background:
- Systemic Inflammatory Response Syndrome (SIRS) can lead to Multiple Organ Dysfunction Syndrome (MODS) due to endothelial damage and hemostatic imbalance.
- Acute Renal Failure (ARF) in SIRS patients may benefit from non-renal effects of Continuous Renal Replacement Therapies (CRRT).
Purpose of the Study:
- To investigate the impact of CRRT on hemostatic and endothelial markers in SIRS-associated ARF.
- To compare the effects of continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodiafiltration (CVVHDF) on these markers.
Main Methods:
- Forty patients with SIRS-associated ARF were randomized to CVVH or CVVHDF for 24 hours, then switched.
- Plasma levels of von Willebrand Factor (vWF), thrombomodulin, plasminogen activity inhibitor type 1 (PAI-1), tissue plasminogen activator (t-PA), prothrombin fragment 1+2 (F1+2), and thrombin-antithrombin complexes (TAT) were measured at baseline, 24, and 48 hours.
- Multivariate ANOVA was used for statistical analysis.
Main Results:
- A significant decrease in PAI-1 activity was observed during CRRT (p <0.05).
- PAI-1 antigen showed a trend towards decrease, but without statistical significance.
- No significant differences in other analyzed factors or between CVVH and CVVHDF methods were found.
Conclusions:
- CRRT may reduce PAI-1 levels in SIRS patients, potentially leading to better outcomes.
- Both CVVH and CVVHDF appear equally effective in modulating the analyzed hemostatic markers.
- The study confirms significant endothelial and hemostatic dysfunction in early-stage SIRS.