Effect of Regional Citric acid Anticoagulation on NLRP-3 and Downstream Inflammatory Factors Expression in Patients with AKI after Cardiopulmonary Bypass

Zheng-jiang XING; Ya-xiong LI; Hong-lin ZOU; Zhen-kun YU; Wen-jun LI; Yun TANG; Zheng JIA

doi:10.12259/j.issn.2095-610X.S20211221

Volume 42 Issue 12

Dec. 2021

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Article Navigation > Journal of Kunming Medical University > 2021 > 42(12): 59-66

Zheng-jiang XING, Ya-xiong LI, Hong-lin ZOU, Zhen-kun YU, Wen-jun LI, Yun TANG, Zheng JIA. Effect of Regional Citric acid Anticoagulation on NLRP-3 and Downstream Inflammatory Factors Expression in Patients with AKI after Cardiopulmonary Bypass[J]. Journal of Kunming Medical University, 2021, 42(12): 59-66. doi: 10.12259/j.issn.2095-610X.S20211221

Citation:

Zheng-jiang XING, Ya-xiong LI, Hong-lin ZOU, Zhen-kun YU, Wen-jun LI, Yun TANG, Zheng JIA. Effect of Regional Citric acid Anticoagulation on NLRP-3 and Downstream Inflammatory Factors Expression in Patients with AKI after Cardiopulmonary Bypass[J]. Journal of Kunming Medical University, 2021, 42(12): 59-66. doi: 10.12259/j.issn.2095-610X.S20211221

Citation:

Zheng-jiang XING, Ya-xiong LI, Hong-lin ZOU, Zhen-kun YU, Wen-jun LI, Yun TANG, Zheng JIA. Effect of Regional Citric acid Anticoagulation on NLRP-3 and Downstream Inflammatory Factors Expression in Patients with AKI after Cardiopulmonary Bypass[J]. Journal of Kunming Medical University, 2021, 42(12): 59-66. doi: 10.12259/j.issn.2095-610X.S20211221

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Effect of Regional Citric acid Anticoagulation on NLRP-3 and Downstream Inflammatory Factors Expression in Patients with AKI after Cardiopulmonary Bypass

doi: 10.12259/j.issn.2095-610X.S20211221

Dept. of Cardiovascular Surgery，Affiliated Yan’an Hospital，Kunming Medical University， Kunming Yunnan 650051，China

Received Date: 2021-10-17
Available Online: 2021-12-01
Publish Date: 2021-12-15

Abstract

Abstract

Objectives To explore the effects of regional citric acid anticoagulation on the expression of NLRP3 and its downstream inflammatory pathway in patients with acute kidney injury （AKI） after cardiopulmonary bypass （CPB）. Methods A total of 37 patients with acute kidney injury who received open-heart surgery assisted by cardiopulmonary bypass from April 2019 to April 2021 in The Department of Cardiovascular Surgery, Yan’an Hospital Affiliated to Kunming Medical University were selected, including 31 patients in the AKI group requiring CRRT after cardiac surgery. 32 patients without AKI after cardiac surgery were randomly selected as the control group. Cardiac ultrasound, cardiopulmonary bypass auxiliary time, liver and kidney function, myocardial enzymology and other baseline data were measured in each group. The mRNA relative expression levels of NLRP-3 and apoptotic pathway caspase-1 were determined by qRT-PCR, and the expression levels of downstream cytokines （IL-1β, IL-6, IL-18） were determined by ELISA. The correlation between NLRP-3 and the above indicators was analyzed. Results Compared with the control group, the auxiliary time of cardiopulmonary bypass （cardiopulmonary bypass time, blocking time, stop time and parallel circulation time） in AKI group was significantly longer （P < 0.05）. qRT-PCR results showed that in AKI group, the mRNA expressions of NLRP-3 and Caspase-1 decreased after 24 h and 48 h CVVH treatment compared with before treatment （P < 0.05）, and further decreased with the prolonged treatment time （P < 0.05）. In the control group, the mRNA expressions of NLRP-3 and Caspase-1 increased at all postoperative time points compared with those before surgery （P < 0.05）, and began to decrease at 48h after surgery （P < 0.05）. ELISA results showed that in AKI group, the expression of downstream cytokines IL-1β, IL-6 and IL-18 decreased after 24h and 48h CVVH treatment compared with before treatment （P < 0.05）. In the control group, the expressions of downstream cytokines Il-1 β, Il-6 and Il-18 at all postoperative time points were increased compared with those before surgery （P < 0.05）, and began to decrease 48h after surgery （P < 0.05）. Spearman correlation analysis indicated that nlRP-3 expression was positively correlated with blocking time and stopping time after regional citric acid anticoagulant CVVH treatment （R = 0.514, P = 0.003; R = 0.401, P = 0.025）. Conclusions The expression of NLRP-3 and downstream inflammatory factors increased in patients with AKI after cardiopulmonary bypass. Regional citric acid anticoagulation can effectively reduce the expression of NLRP-3 and downstream inflammatory factors. NLRP-3 expression after CVVH treatment was positively correlated with blocking time and stopping time.
- NLRP-3,
- Regional citrate anticoagulation,
- Cardiopulmonary bypass,
- Acute kidney injury,
- Inflammatory factors

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References(18)

References

[1]	Englberger L,Suri R M,Li Z,et al. Clinical accuracy of RIFLE and acute kidney injury network(AKIN) criteria for acute kidney injury in patients undergoing cardiac surgery[J]. Crit Care,2011,15(1):16.
[2]	Pickering J W,James M T,Palmer S C. Acute kidney injury and prognosis after cardiopulmonary bypass:A meta - analysis of cohort studies[J]. Am J Kidney Dis,2015,65(2):283-293. doi: 10.1053/j.ajkd.2014.09.008
[3]	Matthew H,Tezcan O B,Paul T,et al. Cardiovascular-specific mortality and kidney disease in patients undergoing vascular surgery[J]. JAMA Surg,2016,151(5):441-450. doi: 10.1001/jamasurg.2015.4526
[4]	Schmitz M,Joannidis M,Czock D,et al. Regional citrate anticoagulation in renal replacement therapy in the intensive care station:Recommendations from the renal section of the DGIIN,OGIAIN and DIVI[J]. Med Klin Intensivmed Notfmed,2018,113(5):377-383. doi: 10.1007/s00063-018-0445-7
[5]	Kidney disease:Improving global outcomes (KIDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury[J]. Nephron Clin Pract,2012,120(4):179-184.
[6]	Karkar A,Ronco C. Prescription of CRRT:A pathway to optimize therapy[J]. Ann Intensive Care,2020,10(1):32. doi: 10.1186/s13613-020-0648-y
[7]	Vinicius A O,Orestes F N,Ingrid K W,et al. Inflammation in renal diseases:New and old players[J]. Front Pharmacol,2019,10(10):1192.
[8]	Stutz A,Kolbe C,Stahl R,et al. NLRP3 inflammasome assembly is regulated by phosphorylation of the pyrin domain[J]. J Exp Med,2017,214(6):1725-1736. doi: 10.1084/jem.20160933
[9]	Vives M,Hernandez A,Parramon F,et al. Acute kidney injury after cardiac surgery:Prevalence,impact and management challenges[J]. Int J Nephrol Renovasc Dis,2019,12(7):153-166.
[10]	Gao D,Jing S,Zhang Q,et al. Pterostilbene protects against acute renal ischemia reperfusion injury and inhibits oxidative stress,inducible nitric oxide synthase expression and inflammation in rats via the Toll-like receptor 4/nuclear factor-κB signaling pathway[J]. Exp Ther Med,2018,15(1):1029-1035.
[11]	Hoste E A,Vandenberghe W. Epidemiology of cardiac surgery-associated acute kidney injury[J]. Best Pract Res Clin Anaesthesiol,2017,31(3):299-303. doi: 10.1016/j.bpa.2017.11.001
[12]	Wijeysundera D N,Karkouti K,Dupuis J Y,et al. Derivation and validation of a simplified predictive index for renal replacement therapy after cardiac surgery[J]. JAMA,2007,297(16):1801-1809. doi: 10.1001/jama.297.16.1801
[13]	Lassnigg A,Schmidlin D,Mouhieddine M,et al. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery:A prospective cohort study[J]. J Am Soc Nephrol,2004,15(6):1597-1605. doi: 10.1097/01.ASN.0000130340.93930.DD
[14]	Clementi A,Virzì G M,Brocca A,et al. The Role of Cell-Free Plasma DNA in Critically Ill Patients with Sepsis[J]. Blood Purif,2016,41(1-3):34-40. doi: 10.1159/000440975
[15]	Strobl K,Harm S,Weber V,et al. The role of ionized calcium and magnesium in regional citrate anticoagulation and its impact on inflammatory parameters[J]. Int J Artif Organs,2017,40(1):15-21. doi: 10.5301/ijao.5000558
[16]	Yin L,Zhao H X,Zhang H Y,et al. Remdesivir alleviates acute kidney injury by inhibiting the activation of NLRP3 inflammasome[J]. Front Immunol,2021,12(5):652446.
[17]	Pang Y,Zhang P C,Lu R R,et al. Andrade-oliveira salvianolic acid B modulates Caspase-1-mediated pyroptosis in renal ischemia-reperfusion injury via Nrf2 pathway[J]. Front Pharmacol,2020,11(9):541426.
[18]	Lee D W,Kim J S,Kim Y,et al. Catheter-based renal sympathetic denervation induces acute renal inflammation through activation of caspase-1 and NLRP3 inflammasome[J]. Anatol J Cardiol,2019,21(3):134-141.

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