Continuous renal replacement therapy in severe acute pancreatitis patients: with or without acute kidney injury

doi:10.3877/cma.j.issn.2096-1537.2017.03.011

Abstract

Abstract:

Severe acute pancreatitis (SAP) is a systemic inflammatory disease characterized by sudden occurrence, complications and high mortality. Since continuous renal replacement therapy (CRRT) has a role in the removal of inflammatory cytokines, a growing number of SAP patients in China have received CRRT, regardless of whether the patient with acute kidney injury (AKI) or not. In this review, we talk about the pathophysiology, inflammatory factor clearance and clinical effect of CRRT in SAP in order to give a rational understanding of its therapeutic value. In addition, the prospects of hybrid blood purification technology in SAP treatment are also discussed.

Key words: Severe acute pancreatitis, Acute kidney injury, Continuous renal replacement therapy, Blood purification

Yijia Jiang, Wenxiong Li. Continuous renal replacement therapy in severe acute pancreatitis patients: with or without acute kidney injury[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2017, 03(03): 208-213.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2017.03.011

https://icu.cma-cmc.com.cn/EN/Y2017/V03/I03/208

Figures/Tables 1

References 47

1	Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus[J]. Gut, 2013, 62(1): 102-111.
2	祝伊琳, 陈江华. 连续性血液净化治疗急性重症胰腺炎的进展[J]. 国际移植与血液净化杂志, 2007, 5(2): 1-4.
3	Schetz M, Forni LG, Joannidis M. Does this patient with AKI need RRT[J]? Intensive Care Med, 2016, 42(7): 1155-1158.
4	VA/NIH Acute Renal Failure Trial Network, Palevsky PM, Zhang JH, O′Connor TZ, et al. Intensity of renal support in critically ill patients with acute kidney injury[J]. N Engl J Med, 2008, 359(1): 7-20.
5	RENAL Replacement Therapy Study Investigators, Bellomo R, Cass A, Cole L, et al. Intensity of continuous renal-replacement therapy in critically ill patients[J]. N Engl J Med, 2009, 361(17): 1627-1638.
6	Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury[J]. Kidney Int, 2012, suppl 2: 95-100.
7	Makhija R, Kingsnorth AN. Cytokine storm in acute pancreatitis[J]. J Hepatobiliary Pancreat Surg, 2002, 9(4): 401-410.
8	卢义展, 王湘英. 微循环障碍在重症性急性胰腺炎发病机制中的地位[J]. 中华胰腺病杂志 2010, 10(2): 144-146.
9	Zerem E. Treatment of severe acute pancreatitis and its complications[J]. World J Gastroenterol, 2014, 20(38): 13879-13892.
10	Beger HG, Rau BM. Severe acute pancreatitis: Clinical course and management[J]. World J Gastroenterol, 2007, 13(38): 5043-5051.
11	Besselink MG, van Santvoort HC, Boermeester MA, et al. Timing and impact of infections in acute pancreatitis[J]. Br J Surg, 2009, 96(3): 267-273.
12	Abe R, Oda S, Shinozaki K, et al. Continuous hemodiaﬁltration using a polymethyl methacrylate membrane hemoﬁlter for severe acute pancreatitis[J]. Contrib Nephrol, 2010, 166: 54-63.
13	Jiang HL, Xue WJ, Li DQ, et al. Inﬂuence of continuous veno-venous hemoﬁltration on the course of acute pancreatitis[J]. World J Gastroenterol, 2005, 11(31): 4815-4821.
14	Xie H, Ji D, Gong D, et al. Continuous veno venous hemoﬁltration in treatment of acute necrotizing pancreatitis[J]. Chin Med J (Engl), 2003, 116(4): 549-553.
15	Guo H, Suo DW, Zhu HP, et al. Early blood purification therapy of severe acute pancreatitis complicated by acute lung injury[J]. Eur Rev Med Pharmacol Sci, 2016, 20(5): 873-878.
16	Gong D, Zhang P, Ji D, et al. Improvement of immune dysfunction in patients with severe acute pancreatitis by high-volume hemofiltration: a preliminary report[J]. Int J Artif Organs, 2010, 33(1): 22-29.
17	Guo J, Huang W, Yang XN, et al. Short-term continuous high-volume hemofiltration on clinical outcomes of severe acute pancreatitis[J]. Pancreas, 2014, 43(2): 250-254.
18	Brendolan A, D’Intini V, Ricci Z, et al. Pulse high volume hemofiltration[J]. Int J Artif Organs, 2004, 27(5): 398-403.
19	Chu LP, Zhou JJ, Yu YF, et al. Clinical effects of pulse high-volume hemoﬁltration on severe acute pancreatitis complicated with multiple organ dysfunction syndrome[J]. Ther Apher Dial, 2013, 17(1): 78-83.
20	Chelazzi C, Giugni D, Giannoni C, et al. Use of continuous veno venous hemodiafiltration with a high cutoff membrane in a patient with severe acute pancreatitis[J]. Open Journal of Nephrology, 2012, 2(4): 78-81.
21	Chen CC, Wang SS, Lu RH, et al. Serum interleukin 10 and interleukin 11 in patients with acute pancreatitis[J]. Gut, 1999, 45(6): 895-899.
22	Kylänpää ML, Repo H, Puolakkainen PA. Inflammation and immunosuppression in severe acute pancreatitis[J]. World J Gastroenterol [J], 2010, 16(23): 2867-2872.
23	Mentula P, Kylänpää-Bäck M L, Kemppainen E, et al. Decreased HLA (human leucocyte antigen)-DR expression on peripheral blood monocytes predicts the development of organ failure in patients with acute pancreatitis[J]. Clin Sci, 2003, 105(4): 409-417.
24	Richter A, Nebe T, Wendl K, et al. HLA-DR expression in acute pancreatitis[J]. Eur J of Surg, 1999, 165(10): 947-951.
25	季大玺, 黎磊石. 重症急性胰腺炎的连续性血液净化治疗[J]. 医学研究生学报, 2010, 23(4): 337-341.
26	Ronco C, Brendolan A, Dan M, et al. Adsorption in sepsis[J]. Kidney Int Suppl, 2000, 76: S148-S155.
27	Su X, Bai C, Hong Q, et al. Effect of continuous hemofiltration on hemodynamics, lung inflammation and pulmonary edema in a canine model of acute lung injury[J]. Intensive Care Med, 2003, 29(11): 2034-2042.
28	Cui HX, Xu JY, Li MQ. Efficacy of continuous renal replacement therapy in the treatment of severe acute pancreatitis associated acute respiratory distress syndrome[J]. Eur Rev Med Pharmacol Sci, 2014, 18(17): 2523-2526.
29	Farkas G, Márton J, Nagy Z, et al. Experimental acute pancreatitis results in increased blood-brain barrier permeability in the rat: a potential role for tumor necrosis factor and interleukin 6[J]. Neurosci Lett, 1998, 242(3): 147-150.
30	Yang YL, Li JP, Li KZ, et al. Tumor necrosis factor alpha antibody prevents brain damage of rats with acute necrotizing pancreatitis[J]. World J of Gastroenterol, 2004, 10(19): 2898-2900.
31	Pupelis G, Plaudis H, Zeiza K, et al. Early continuous veno-venous haemofiltration in the management of severe acute pancreatitis complicated with intra-abdominal hypertension: retrospective review of 10 years′ experience[J]. Ann Intensive Care, 2012, 2(Suppl 1): S21.
32	Xu J, Tian X, Zhang C, et al. Management of abdominal compartment syndrome in severe acute pancreatitis patients with early continuous veno-venous hemofiltration[J]. Hepatogastroenterol, 2013, 60(127): 1749-1752.
33	Oda S, Hirasawa H, Shiga H, et al. Management of intra-abdominal hypertension in patients with severe acute pancreatitis with continuous hemodiafiltration using a polymethyl methacrylate membrane hemofilter[J]. Ther Apher Dial, 2005, 9(4): 355-361
34	Kirkpatrick AW, Roberts DJ, De WJ, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome[J]. Intensive Care Med, 2013, 39(7): 1190-1206.
35	Chen ZH, Liu ZH, Yu C, et al. Endothelial dysfunction in patients with severe acute pancreatitis: improved by continuous blood purification therapy[J]. Int J Artif Organs, 2007, 30(5): 393-400.
36	Yu C, Liu ZH, Chen ZH, et al. Improvement of monocyte function and immune homeostasis by high volume continuous venovenous hemoﬁltration in patients with severe acute pancreatitis[J]. Int J Artif Organs, 2008, 31(10): 882-890.
37	Zhu Y, Yuan J, Zhang P, et al. Adjunctive continuous highvolume hemoﬁltration in patients with acute severe pancreatitis: a prospective nonrandomized study[J]. Pancreas, 2011, 40(1): 109-113.
38	Zhu Y, Zhang P, Yuan J, et al. Adjunctive continuous high-volume hemoﬁltration in acute severe pancreatitis patients: a retrospective study[J]. Scand J Gastroenterol, 2009, 44(11): 1363-1369.
39	Hirasawa H. Indications for blood puriﬁcation in critical care[J]. Contrib Nephrol, 2010, 166(166): 21-30.
40	Zhang XJ, Sun SR, Li SJ, et al. Early classic hemoﬁltration exhibits no beneﬁts in severe acute pancreatitis with early organ failure: a retrospective case-matched study[J]. Int J Artif Organs, 2014, 38(4): 335-341.
41	He C, Zhang L, Shi W, et al. Coupled plasma filtration adsorption combined with continuous veno-venous hemofiltration treatment in patients with severe acute pancreatitis[J]. J Clin Gastroenterol, 2013, 47(1): 62-68.
42	Shimada M. A challenging case of severe acute hypertriglyceridemia-induced pancreatitis[J]. South Med J, 2009, 102(10): 999-1000.
43	Reper P, Attou R, Gucciardo L, et al. Early plasmapheresis as a successful treatment in hypertriglyceridemia-induced acute pancreatitis in first trimester pregnancy following in vitro fertilization[J]. Eur J Obstet Gynecol Reprod Biol, 2014, 179: 257-258.
44	Navarro S, Cubiella J, Feu F, et al. Hypertriglyceridemic acute pancreatitis. Is its clinical course different from lithiasis acute pancreatitis[J]. Med Clin (Barc), 2004, 123(15): 567-570.
45	Li MQ, Shi ZX, Xu JY, et al. Hemodiafiltration combined with resin-mediated absorption as a therapy for hyperlipidemic acute pancreatitis[J]. Cell Biochem Biophys, 2014, 69(3): 699-702.
46	Sun S, He L, Bai M, et al. High-volume hemofiltration plus hemoperfusion for hyperlipidemic severe acute pancreatitis: a controlled pilot study[J]. Ann Saudi Med, 2015, 35(5): 352-358.
47	Wang HL, Yu KJ. Sequential blood purification therapy for critical patients with hyperlipidemic severe acute pancreatitis[J]. World J Gastroenterol, 2015, 21(20): 6304-6309.

研究者	病例数	试验设计	治疗模式	细胞因子	治疗时间（h）					临床情况	APACHE-Ⅱ	病死率（例数/例数）
研究者	病例数	试验设计	治疗模式	细胞因子	6	12	24	48	72	临床情况	APACHE-Ⅱ	病死率（例数/例数）
Abe等^[12]	82	系列病例研究	CVVH	IL-6	NS	NS	NS	↓	↓	改善	NR	5/82
Jiang等^[13]	37	系列病例研究	CVVH	IL-1β	↓	NS	NS	NS	NS	NR	NR	7/37
				TNF-α	↓	↓	↓	↓	↓
				IL-6	NS	NS	NS	↓	↓
				IL-1	NS	NS	NS	NS	↓
Xie等^[14]	13	系列病例研究	CVVH	IL-1β	↓	NS	NS	NS	NS	改善	↓	4/13
				TNF-α	↓	↓	↓	↓	↓
Gu^o等^[15]	64	前瞻性队列研究	CVVH	TNF-α	NR	NR	NR	NR	↓	改善	↓	0/32（CVVH）
				IL-10	NR	NR	NR	NR	↓			0/32（control）
Yu等^[36]	16	系列病例研究	HVHF	IL-10	↓	↓	↓	↓	↓	NR	↓	NR
				TNF-α	↓	↓	↓	↓	↓
				IL-6	NS	NS	NS	↓	↓
				IL-1	NS	NS	NS	NS	↓
Gong等^[16]	12	前瞻性队列研究	HVHF	IL-10	↓	↓	↓	↓	↓	NR	NR	1/8（HVHF）
				TNF-α	↓	↓	↓	↓	↓			1/4（control）
				IL-13	NS	↓	NS	↓	↓
				IL-1	NS	NS	NS	NS	↓
				IL-2	NS	NS	NS	NS	↓
				IL-5	NS	NS	NS	NS	↓
				IFN-γ	NS	NS	NS	NS	↓
Guo等^[17]	61	前瞻性队列研究	HVHF	IL-6	NR	NR	NS	NR	↓	改善	↓	8/25（HVHF）
												15/29（control）
Chu等^[19]	30	前瞻性队列研究	pHVHF	IL-6	NR	NR	NR	NR	↓	改善	↓	3/15（pHVHF）
				IL-10	NR	NR	NR	NR	↓			5/15（CVVH）
				TNF-α	NR	NR	NR	NR	↓

研究者	病例数	试验设计	治疗模式	细胞因子	治疗时间（h）					临床情况	APACHE-Ⅱ	病死率（例数/例数）
研究者	病例数	试验设计	治疗模式	细胞因子	6	12	24	48	72	临床情况	APACHE-Ⅱ	病死率（例数/例数）
Abe等^[12]	82	系列病例研究	CVVH	IL-6	NS	NS	NS	↓	↓	改善	NR	5/82
Jiang等^[13]	37	系列病例研究	CVVH	IL-1β	↓	NS	NS	NS	NS	NR	NR	7/37
				TNF-α	↓	↓	↓	↓	↓
				IL-6	NS	NS	NS	↓	↓
				IL-1	NS	NS	NS	NS	↓
Xie等^[14]	13	系列病例研究	CVVH	IL-1β	↓	NS	NS	NS	NS	改善	↓	4/13
				TNF-α	↓	↓	↓	↓	↓
Gu^o等^[15]	64	前瞻性队列研究	CVVH	TNF-α	NR	NR	NR	NR	↓	改善	↓	0/32（CVVH）
				IL-10	NR	NR	NR	NR	↓			0/32（control）
Yu等^[36]	16	系列病例研究	HVHF	IL-10	↓	↓	↓	↓	↓	NR	↓	NR
				TNF-α	↓	↓	↓	↓	↓
				IL-6	NS	NS	NS	↓	↓
				IL-1	NS	NS	NS	NS	↓
Gong等^[16]	12	前瞻性队列研究	HVHF	IL-10	↓	↓	↓	↓	↓	NR	NR	1/8（HVHF）
				TNF-α	↓	↓	↓	↓	↓			1/4（control）
				IL-13	NS	↓	NS	↓	↓
				IL-1	NS	NS	NS	NS	↓
				IL-2	NS	NS	NS	NS	↓
				IL-5	NS	NS	NS	NS	↓
				IFN-γ	NS	NS	NS	NS	↓
Guo等^[17]	61	前瞻性队列研究	HVHF	IL-6	NR	NR	NS	NR	↓	改善	↓	8/25（HVHF）
												15/29（control）
Chu等^[19]	30	前瞻性队列研究	pHVHF	IL-6	NR	NR	NR	NR	↓	改善	↓	3/15（pHVHF）
				IL-10	NR	NR	NR	NR	↓			5/15（CVVH）
				TNF-α	NR	NR	NR	NR	↓

[1]	Shengjin Han, Zhengwu Zhou, Yunlong Weng, Xin Huang. Effect of sodium bicarbonate Ringer's solution combined with continuous renal replacement therapy on inflammation level and renal function in trauma patients with acute kidney injury [J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2023, 16(05): 376-381.
[2]	Yuanyuan Han, Sabeiti Reziya, Zhijie Mao, Aierken Mufunayi, Chen Lu, Xiaohong Sang, Mulati Aerman, Li Zhang. Effect of combined blood purification on serum inflammatory cytokines levels and clinical prognosis in patients with sepsis [J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2023, 16(04): 272-278.
[3]	Xiaoqiao Mo, Zheying Hu, Donghua Liao, Tian Xie. Establishment and evaluation of a predictive model for death risk in patients with acute kidney injury secondary to sepsis [J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2023, 16(03): 198-206.
[4]	lei Xu, Jie Sun, Xianzhi Chen. Application of hemopurification for hyperlipidemic severe pancreatitis [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(04): 464-468.
[5]	Qinglin Li, Renjie Song, Feihu Zhou. Establishment and exploration of a mouse model of severe exertional heat stroke-related acute kidney injury [J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2023, 12(05): 265-270.
[6]	Jiafa Ren, Buyun Wu, Changying Xing, Huijuan Mao. Advances in the basic and clinical research on acute kidney injury in 2022 [J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2023, 12(05): 276-281.
[7]	Jinpu Li, Xiangrong Rao. Antiviral drugs and acute kidney injury [J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2023, 12(05): 287-290.
[8]	Ruanxin Miao, Xi Qiao. Role of Toll-like receptor in sepsis-induced acute kidney injury [J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2023, 12(04): 210-214.
[9]	Na Li, Guozhen Zhu. Progress of research on the roles of gut microbiota and its metabolites in acute kidney injury [J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2023, 12(04): 215-219.
[10]	Yanqi Song, Xuejing Ren, Wenjuan Wang, Qiuxia Han, Yue Xu, Kaiting Zhuang, Tuo Xiao, Guangyan Cai. Effect of mesenchymal stem cells on ferroptosis in cisplatin-induced acute kidney injury of mice [J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2023, 12(04): 187-193.
[11]	Tianyu Yu, Yue Yang, Haitao Lu, Zhiyong Tian, Wenge Li. Prognosis and its influencing factors in elderly AKI patients after continuous renal replacement therapy [J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2023, 12(03): 134-138.
[12]	Junlong Gao, Xin Zhang, Qianqian Zhou, Yuan. Yuan. Advances in immunosuppression for early severe acute pancreatitis [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2023, 09(03): 286-291.
[13]	Xiaohong Wang, Jing Qian, Wenjun Weng, Guoxiong Zhou, Shunxing Zhu, Xiaoming Qi, Chun Liu, Ping Wang, Wei Shen, Ruizhi Cheng, Jinghao Qin. Effects of regulation of nuclear factor-κB signal by mercaptopyruvate sulfurtransferase mediated autophagy on rats with severe acute pancreatitis and its mechanism [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 422-426.
[14]	Qiang Ma, Jun Li, Lijuan Gou. Expression levels of miR-21-3p and RUNX3 in severe acute pancreatitis and their predictive value to the progression of the disease [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(05): 337-341.
[15]	Cheng Yi, Wei Wei, Yuliang Zhao. The last piece of picture puzzle: conceptual evolution of acute kidney disease [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(08): 906-910.

Please choose a citation manager

Content to export