Case Control Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2020; 8(13): 2738-2748
Published online Jul 6, 2020. doi: 10.12998/wjcc.v8.i13.2738
Effects of prostaglandin E combined with continuous renal replacement therapy on septic acute kidney injury
Li Lei, Ming-Jun Wang, Sheng Zhang, Da-Jun Hu
Li Lei, Ming-Jun Wang, Sheng Zhang, Da-Jun Hu, Department of Nephrology, the Second People's Hospital of Three Gorges University (Yichang Second People's Hospital), Yichang 443000, Hubei Province, China
Li Lei, Ming-Jun Wang, Sheng Zhang, Da-Jun Hu, Institute of Nephrology of Integrated Chinese and Western Medicine of Three Gorges University, Yichang 443000, Hubei Province, China
Author contributions: Lei L and Wang MJ contributed equally to this study; Hu DJ wrote the first draft of the manuscript; Lei L, Wang MJ, and Zhang S performed the material preparation and data collection and analysis; all authors contributed to the study conception and design, commented on previous versions of the manuscript, and read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Yichang Second People's Hospital.
Informed consent statement: All participates provided written informed consent prior to study inclusion.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Da-Jun Hu, BSc, Attending Doctor, Department of Nephrology, the Second People's Hospital of Three Gorges University (Yichang Second People's Hospital), No. 21, Xiling 1 Road, Yichang 443000, Hubei Province, China. hudiba2872@163.com
Received: February 27, 2020
Peer-review started: February 27, 2020
First decision: April 21, 2020
Revised: May 25, 2020
Accepted: June 9, 2020
Article in press: June 9, 2020
Published online: July 6, 2020
Abstract
BACKGROUND

The effects of prostaglandin E (PGE) combined with continuous renal replacement therapy (CRRT) on renal function and inflammatory responses in patients with septic acute kidney injury (SAKI) remain unclear.

AIM

To investigate the effects of PGE combined with CRRT on urinary augmenter of liver regeneration (ALR), urinary Na+/H+ exchanger 3 (NHE3), and serum inflammatory cytokines in patients with SAKI.

METHODS

The clinical data of 114 patients with SAKI admitted to Yichang Second People's Hospital from May 2017 to January 2019 were collected. Fifty-three cases treated by CRRT alone were included in a control group, while the other 61 cases treated with PGE combined with CRRT were included in an experimental group. Their urinary ALR, urinary NHE3, serum inflammatory cytokines, renal function indices, and immune function indices were detected. Changes in disease recovery and the incidence of adverse reactions were observed. The 28-d survival curve was plotted.

RESULTS

Before treatment, urinary ALR, urinary NHE3, blood urea nitrogen (BUN), serum creatinine (SCr), CD3+ T lymphocytes, CD4+ T lymphocytes, and CD4+/CD8+ T lymphocyte ratio in the control and experimental groups were approximately the same. After treatment, urinary ALR and NHE3 decreased, while BUN, SCr, CD3+ T lymphocytes, CD4+ T lymphocytes, and CD4+/CD8+ T lymphocyte ratio increased in all subjects. Urinary ALR, urinary NHE3, BUN, and SCr in the experimental group were significantly lower than those in the control group, while CD3+ T lymphocytes, CD4+ T lymphocytes, and CD4+/CD8+ T lymphocyte ratio were significantly higher than those in the control group (P < 0.05). After treatment, the levels of tumor necrosis factor-α, interleukin-18, and high sensitivity C-reactive protein in the experimental group were significantly lower than those in the control group (P < 0.05). The time for urine volume recovery and intensive care unit treatment in the experimental group was significantly shorter than that in the control group (P < 0.05), although there was no statistically significant difference in hospital stays between the two groups. The total incidence of adverse reactions did not differ statistically between the two groups. The 28-d survival rate in the experimental group (80.33%) was significantly higher than that in the control group (66.04%).

CONCLUSION

PGE combined with CRRT is clinically effective for treating SAKI, and the combination therapy can significantly improve renal function and reduce inflammatory responses.

Keywords: Prostaglandin E, Continuous renal replacement therapy, Septic acute kidney injury, Augmenter of liver regeneration, Na+/H+ exchanger 3, Serum inflammatory cytokines

Core tip: Prostaglandin E combined with continuous renal replacement therapy is clinically effective for treating septic acute kidney injury, and the combination therapy can significantly improve renal function and reduce inflammatory responses. However, there are still unsolved problems in this study. For instance, the patient survival has been observed for 28 d, and causes of patient death are various, but no detailed analysis has been made on changes in the survival rate to improve the selection accuracy of therapeutic schemes. In addition, more reference directions for adverse reactions can be provided to improve the safety of drugs. These deficiencies will be our further research direction, so as to provide effective measures for the early treatment of patients with septic acute kidney injury.