[Metabolic effects of intermittent hemofiltration in patients with acute renal failure].

AIM

Investigation of postaggressive reaction of metabolism on intermitten hemofiltration (IHF) in patients with acute renal failure (ARF). The speed of generation of urea, creatinine and oligopeptides was estimated in the course of (IHF) and in interval between the procedures. Hormonal stress was evaluated by concentration of hydrocortisone in plasma and and filtrate.

MATERIALS AND METHODS

The trial covered 36 patients with oliguric ARF (21 males and 15 females) for whom IHF was the main method of replacement renal therapy. The kinetic modelling accounted for distinctive distribution of markers in body fluids. Statistical processing was made according to Student-Fisher T-criterion.

RESULTS

IHF runs with intensive proteinolysis with acceleration of oligopeptides generation by 810%, degradation of large quantities of creatine triphosphate and 770%-accelerated production of creatinine, with protein catabolism and 440%-accelerated production of urea. Hydrocortisone blood levels rise about two-fold despite intensive elimination of the hormone with filtrate. Between speeds of IHF, generation of creatinine and secretion a direct correlation was found. This indicates the importance of the perfusion rate for induction of the stress and catabolism. Background hydrocortisone Irvrl has significant effects only on urea accumulation rates in IHF-free intervals. However, in the course of IHF, generation of urea and oligopeptides is to a great extent independent of hydrocortisone secretion.

CONCLUSION

Application of IHF in ARF patients results in rather strong stress with enhanced proteinolysis and protein catabolism. To compensate protein loss associated with only urea generation, additional administration of minimum 60 g of plasma or amino acids is required.