Effects of continuous renal replacement therapy on inflammation-related anemia, iron metabolism and prognosis in sepsis patients with acute kidney injury

doi:10.5847/wjem.j.1920-8642.2023.052

Abstract

Abstract:

BACKGROUND: This study aims to evaluate the effect of continuous renal replacement therapy (CRRT) on inflammation-related anemia, iron metabolism, and the prognosis in sepsis patients with acute kidney injury (AKI).

METHODS: Sepsis patients with AKI were prospectively enrolled and randomized into the CRRT and control groups. The clinical and laboratory data on days 1, 3 and 7 after intensive care unit (ICU) admission were collected. The serum interleukin (IL)-6, hepcidin, erythropoietin, ferritin, and soluble transferrin receptor (sTfR) were determined by enzyme-linked immunosorbent assay. The Sequential Organ Failure Assessment (SOFA) score and 28-day mortality were recorded. Data were analyzed using Pearson’s Chi-square test or Fisher’s exact test (categorical variables), and Mann-Whitney U-test or t-test (continuous variables).

RESULTS: The hemoglobin and serum erythropoietin levels did not significantly differ between the CRRT and control groups though gradually decreased within the first week of ICU admission. On days 3 and 7, the serum IL-6, hepcidin, ferritin, and red blood cell distribution width significantly decreased in the CRRT group compared to the control group (all P<0.05). On day 7, the serum iron was significantly elevated in the CRRT group compared to the control group (P<0.05). However, the serum sTfR did not significantly differ between the groups over time. In addition, the SOFA scores were significantly lower in the CRRT group compared to the control group on day 7. The 28-day mortality did not significantly differ between the control and CRRT groups (38.0% vs. 28.2%, P=0.332).

CONCLUSION: CRRT might have beneficial effects on the improvement in inflammation-related iron metabolism and disease severity during the first week of ICU admission but not anemia and 28-day mortality in sepsis patients with AKI.

Key words: Sepsis, Continuous renal replacement therapy, Acute kidney injury, Anemia, Iron metabolism

Meng-meng An, Chen-xi Liu, Ping Gong. Effects of continuous renal replacement therapy on inflammation-related anemia, iron metabolism and prognosis in sepsis patients with acute kidney injury[J]. World Journal of Emergency Medicine, 2023, 14(3): 186-192.

Figures/Tables 3

Table 1.

Figure 1.

Figure 2.

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Parameters	Control group (n=50)	CRRT group (n=39)	P-value^a
Age, years	76.0 (68.2, 85.1)	74.5 (65.0, 83.3)	0.489
Male gender, n (%)	29 (58.0)	18 (46.2)	0.292
Infection sites, n (%)
Lung	21 (42.0)	12 (30.8)	0.377
Abdomen	13 (26.0)	17 (43.6)	0.114
Biliary system	9 (18.0)	6 (15.4)	0.784
Soft skin tissue	9 (18.0)	4 (10.2)	0.375
Comorbidities, n (%)
Hypertension	28 (56.0)	20 (51.3)	0.675
Diabetes mellitus	20 (40.0)	11 (28.2)	0.271
Stroke Acute myocardial infarction Deep venous thrombosis	1 (2.0) 2 (4.0) 4 (8.0)	0 (0) 0 (0) 1 (2.6)	1.000 0.502 0.380
Post-operative patients, n (%)	7 (14.0)	3 (7.7)	0.503
Patients using vasopressors, n (%)	27 (54.0)	20 (51.5)	0.833
Patients with mechanical ventilation, n (%)	26 (52.0)	17 (43.6)	0.523
Length of mechanical ventilation, h	102.0 (75.8, 136.0)	117.0 (79.0, 151.0)	0.386
PaO₂/FiO₂, mmHg	216.5 (175.8, 245.0)	217.0 (192.0, 244.0)	0.579
Serum procalcitonin, ng/mL	7.32 (2.45, 10.23)	5.00 (1.16, 16.90)	0.993
Serum lactate, mmol/L	4.05 (2.28, 5.53)	3.10 (1.80, 4.90)	0.101
Serum creatinine, µmol/L	242.0 (181.8, 261.3)	247.0 (209.0, 265.0)	0.721
Urine output, mL/(kg·h)	0.32 (0.28, 0.49)	0.37 (0.29, 0.48)	0.735
Serum potassium, mmol/L	4.16 (3.84, 4.58)	4.36 (3.96, 4.65)	0.186
Reticulocytes, ×10⁹/L	66.0 (43.3, 81.3)	50.0 (38.0, 65.0)	0.083
Mean corpuscular volume, fL	88.5 (82.0, 93.0)	88.0 (85.0, 93.0)	0.967
Mean corpuscular hemoglobin, pg	32.0 (30.0, 34.0)	32.0 (29.0, 34.0)	0.800
MCHC, g/L	334.5 (320.8, 347.0)	333.0 (314.0, 348.0)	0.628