Response of volume and osmoregulatory kidney function to infusion loading in patients with dopamine-dependent compensation of sepsis-induced hypotension

Authors

  • V. M. Konovchuk HSEI "Bukovinian State Medical University", Chernivtsi, Ukraine,
  • A. V. Andrushchak HSEI "Bukovinian State Medical University", Chernivtsi, Ukraine,

DOI:

https://doi.org/10.14739/2310-1210.2017.5.110172

Keywords:

kidney function tests, extracellular space, severe sepsis

Abstract

Objective. To study the response of volume and osmoregulatory kidney function to increased volume of extracellular space (IVECS) with dopamine-dependent compensation of sepsis-induced hypotension.

Materials and methods. The inclusion criteria involved patients with purulent-septic complications (predominantly surgical abdominal sepsis) with dopamine-dependent compensation (5–10 μg/kg-min) according to the initial values: SBP >70 mmHg, BPs >95 mmHg, CVP >4 mmHg, diuresis >30 ml/h. The control group consisted of patients with systemic inflammatory response syndrome (SIRS) who met the requirements of ICD-10 classifier: SIRS, ICD-10: R-65.2. All patients were divided into 4 groups: groups I and II for control studies (SIRS, n = 21); groups III and IV included patients with severe sepsis (n = 30). The patients of groups II and IV received an infusion load in the form of Ringer's solution in the amount of 7–8 ml/kg at a rate of 18–20 ml/min.

Results. The depression of glomerular filtration rate (GFR) in the patients from group ІІІ was 41 % (Р < 0.05), the excreted water fraction was 45 % higher than the control value (Р < 0.05), and urine output reached 88 % (Р < 0.05) of that in the comparison group. This result is due to different reabsorption rates. In doing so the sodium clearance was 81 % (P < 0.05) of the SIRS rate. The main cause is a decrease in the sodium filtration fraction, as the reabsorption of the cation according to the values of the excreted fraction was less than the control value. Depression of the osmoregulatory function of the kidneys had the same direction. The comparative analysis of the values between groups ІІ and IV (response of volume and osmoregulatory kidney function in patients with SIRS and severe sepsis (SS) to IVECS) shows that after IVECS the GFR remains reduced and represents 59 % of that in group II. Despite the more intensive compensatory suppression of water reabsorption, sodium and osmotically active substances (OAS) according to the indicators of the excreted fraction of water, sodium and OAS (an increase, Δ, P < 0.05) and a decrease in clearance of sodium-free water, in the reabsorption of osmotically free water (Δ, P < 0.05), in sodium clearance and OAS after IVECS in the patients from group IV were reduced by 16 % and 35 %, in urine output by 26 % (P < 0.05) respectively.

Conclusions. In compensated sepsis-induced hypotension despite the compensatory suppression of water, sodium and OAS reabsorption according to the clearance characteristics there is an inhibition of volume and osmoregulatory kidney function both spontaneously (by 19 and 24 %, Δ, P < 0.05) and, accordingly, after IVECS (by 16 and 35 %, Δ, P < 0.05).

References

Dellinger, R. P., Levy, M. M., Rhodes, A., Annane, D., Gerlach, H., Opal, S. M., et al. (2013). Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock. Crit. Care Med., 41(2), 580–637. doi: 10.1097/CCM.0b013e31827e83af.

Martin, G. (2012). Sepsis, severe sepsis and septic shock: changes in incidence, pathogens and outcomes. Expert Review of Anti-infective Therapy, 10(6), 701–706. doi: 10.1586/eri.12.50.

Avni, T., Lador, A., Lev, S., Leibovici, L., Paul, M., & Grossman, A. (2015). Vasopressors for the Treatment of Septic Shock: Systematic Review and Meta-Analysis. Plos One, 10(8), e0129305. doi: 10.1371/journal.pone.0129305.

Cruz, M., Dantas, J., Levi, T., Rocha, M., Souza, S., Boa-Sorte, N., et al. (2014). Septic versus non-septic acute kidney injury in critically ill patients: characteristics and clinical outcomes. Revista Brasileira de Terapia Intensiva, 26(4), 384–391. doi: 10.5935/0103-507X.20140059.

Greenfield, N., & Balk, R. (2012). Evaluating the Adequacy of Fluid Resuscitation in Patients with Septic Shock: Controversies and Future Directions. Hospital Practice, 40(2), 147–157. doi: 10.3810/hp.2012.04.980.

Warren, M., & Ruppert, S. (2012). Management of a Patient With Severe Sepsis. Critical Care Nursing Quarterly, 35(2), 134–143. doi: 10.1097/CNQ.0b013e31824566ba.

Konovchuk, V. M., Andrushhak, A. V., & Maksymchuk, N. O. (patentee) (2016). Patent № UA 112508 Ukrayina (korysna model) G01N 33/48(2006.01) Sposib otsinky perebihu endohennoi intoksykatsii [Patent № UA 112508 Ukraine (utility model) G01N 33/48(2006.01). The way the course evaluation of endogenous intoxication]. Bulleten, 24. [in Ukrainian].

Mervyn, S., Deutschman, C., Seymour, C., Shankar-Hari, M., Annane, D., Bauer, M., et al. (2016). The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA, 315(8), 801–810. doi: 10.1001/jama.2016.0287.

Konovchuk, V. M., Andrushchak, A. V., & Akentiev, S. O. (2014) Vplyv reosorbilaktu na mekhanizmy rehuliatsii balansu ioniv natriiu u khvorykh na tiazhkyi sepsys [He effect of rheosorbilact on the regulation mechanisms of sodium balance of sepsis patients]. Bukovynskyi medychnyi visnyk, 18, 3(71), 85–88. [in Ukrainian].

Ermolenko, T. I. (2013) Farmakologicheskoe izuchenie specificheskogo dejstviya novogo kombinirovannogo urolitolitika pri giperurikemii [Pharmacological research of specific activity of a new combined urolitholytic in case of hyperuricemia]. Nauchnye vedomosti Belgorodskogo gosudarstvennogo universiteta. Seriya: Medicina. Farmaciya, 4(147), 199–202. [in Russian].

How to Cite

1.
Konovchuk VM, Andrushchak AV. Response of volume and osmoregulatory kidney function to infusion loading in patients with dopamine-dependent compensation of sepsis-induced hypotension. Zaporozhye Medical Journal [Internet]. 2017Oct.17 [cited 2024Nov.13];(5). Available from: http://zmj.zsmu.edu.ua/article/view/110172

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Section

Original research