Kidney Week

Abstract: FR-PO094

In Vitro Assessment of Proenkephalin a 119-159 (PenKid) Removal in Hemofiltration, Hemodialysis, and Hemoadsorption

Session Information

• AKI: Diagnosis and Outcomes
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Lorenzin, Anna, Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza, Italy

Anna Lorenzin, MS, MSc

• Perin, Natascha, Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza, Italy

Natascha Perin

• de Cal, Massimo, Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza, Italy

Massimo de Cal, PhD

• Brendolan, Alessandra, International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy

Alessandra Brendolan

• Lentini, Paolo, Department of Nephrology and Dialysis, St. Bassiano Hospital, Bassano del Grappa (Vicenza), Italy

Paolo Lentini, MD, PhD, FASN

• Zanella, Monica, Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza, Italy

Monica Zanella, MD

• Ronco, Claudio, International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy

Claudio Ronco, MD

Background

PenKid is a stable surrogate marker for enkephalins (endogenous opioids regulating kidney function). PenKid plasma concentration correlates to glomerular filtration rate and increases in acute kidney injury (AKI), therefore it can be used for prediction and diagnosis of AKI, need of renal replacement therapy (RRT), and prediction of the successful weaning. Whether the penKid concentration is affected by RRT, is a controversial point. To address the issue, we simulated in vitro different conditions of RRT: continuous veno-venous hemofiltration (CVVH) to determine the sieving coefficient, continuous veno-venous hemodialysis (CVVHD) to determine diffusive clearance, and hemoadsorption (HA) to define the penKid removal ratio.

Methods

Blood was spiked with lyophilized synthetic penKid to achieve target concentrations: 150 and 500 pmol/L in both CVVH and CVVHD, and 700 pmol/L in HA. For each experiment, a blood batch of 1L was utilized, at 37° and stirred. Circuits and flow rate set-up is shown in Figure 1. AV1000 dialyzer (Fresenius) was utilized for CVVH and CVVHD and samples were taken after 10, 30, 60 minutes from the initiation of circulation. A minimodule of HA380 cartridge (Jafron) was used for HA and samples were taken after 5, 15, 30, 60 and 120 minutes. All the experiments were conducted in triplicate.

Results

Initial penKid concentrations in blood corresponded to the desired targets in all the experiments.
Significant removal of PenKid was observed (Figure 2):
in CVVH sieving coefficients remained stable over time (1.04±0.27)
in CVVHD clearance values decreased over time (23.08±0.89)
in HA removal ratio displayed high values (76.1±1% after 120 minutes)
Remarkable consistency in measured values was observed confirming a consistent interaction between the sorbent and penKid.

Conclusion

Significant removal of penKid was obtained by the extracorporeal modalities tested. Further investigation is needed to assess if these findings are confirmed during in vivo treatments.