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Renal clearance of heparin-binding protein and elimination during renal replacement therapy: Studies in ICU patients and healthy volunteers
Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine (Östersund), Umeå University, Umeå, Sweden.
Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine (Östersund), Umeå University, Umeå, Sweden.
Department of Clinical Sciences, Lund University, Lund, Sweden.
Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine, Umeå University, Umeå, Sweden.
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2019 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 8, article id e0221813Article in journal (Refereed) Published
Abstract [en]

Background: Heparin-binding protein (HBP) is released by neutrophils upon activation, and elevated plasma levels are seen in inflammatory states like sepsis, shock, cardiac arrest, and burns. However, little is known about the elimination of HBP. We wanted to study renal clearance of HBP in healthy individuals and in burn patients in intensive care units (ICUs). We also wished to examine the levels of HBP in the effluent of renal replacement circuits in ICU patients undergoing continuous renal replacement therapy (CRRT).less thanbr /greater thanMethods: We measured plasma and urine levels of HBP and urine flow rate in 8 healthy individuals and 20 patients in a burn ICU. In 32 patients on CRRT, we measured levels of HBP in plasma and in the effluent of the CRRT circuit.less thanbr /greater thanResults: Renal clearance of HBP (median (IQR) ml/min) was 0.19 (0.08-0.33) in healthy individuals and 0.30 (0.01-1.04) in burn ICU patients. In ICU patients with cystatin C levels exceeding 1.44 mg/l, clearance was 0.45 (0.15-2.81), and in patients with cystatin C below 1.44 mg/l clearance was lower 0.28 (0.14-0.55) (p = 0.04). Starting CRRT did not significantly alter plasma levels of HBP (p = 0.14), and the median HBP level in the effluent on CRRT was 9.1 ng/ml (IQR 7.8-14.4 ng/ml).less thanbr /greater thanConclusion: In healthy individuals and critically ill burn patients, renal clearance of HBP is low. It is increased when renal function is impaired. Starting CRRT in critically ill patients does not alter plasma levels of HBP significantly, but HBP can be found in the effluent. It seems unlikely that impaired kidney function needs to be considered when interpreting concentrations of HBP in previous studies. Starting CRRT does not appear to be an effective way of reducing HBP concentrations.

Place, publisher, year, edition, pages
Public Library of Science , 2019. Vol. 14, no 8, article id e0221813
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Anesthesiology and Intensive Care
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URN: urn:nbn:se:liu:diva-160129DOI: 10.1371/journal.pone.0221813ISI: 000485058200055OAI: oai:DiVA.org:liu-160129DiVA, id: diva2:1349133
Available from: 2019-09-06 Created: 2019-09-06 Last updated: 2019-09-30

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Steinvall, IngridSjöberg, Folke
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Division of Surgery, Orthopedics and OncologyFaculty of Medicine and Health SciencesDepartment of Hand and Plastic SurgeryDepartment of Anaesthesiology and Intensive Care in Linköping (ANOPIVA)
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