Effect of plasmosorption on blood protein in patients with renal insufficiency

The problem of effective intensive treatment of endotoxicosis in acute and chronic renal diseases and other conditions associated with renal failure syndrome remains relevant to date [1, 17]. Methods of extracorporeal detoxification (ED) have become conventional in this pathology. They include: hemodialysis (GD), hemosorption (HS), plasmapheresis (PPh) and others. It is believed that methods of efferent therapy is part of complementary therapy [2, 4]. In part agreeing with this thesis, it should be noted that in practice of intensive care ED methods, provided that the body is unable to independently overcome endotoxicosis, become important. After all, the assistance of separate mechanisms of biotransformation, functions of organs and systems, stages of neutralization, elimination of various metabolites and xenobiotics has in these conditions a defining character, rather than merely the role of supportive or, more importantly, complementary therapy. The second aspect of this problem is avoiding the negative effects of detoxifying systems (hemosorbent column, etc.) on the patient's body. The authors have some experience in using the method of plasma sorption (PS) with this syndrome caused by a number of nosological forms of kidney disease, with different etiology, pathogenesis, clinic, morphology and prognosis [3, 36]. PS is an effective detoxification method based on sorption technology that accumulates positive characteristics of the HS and PPh.

Objective. To study the dynamics of total protein and its fractions in patients with renal insufficiency syndrome against the background of application of efferent methods of detoxification.

Materials and methods. PS was performed in complex treatment for 20 patients (37 sessions). PS was carried out in the first 1-2 days of the patient's admission to the intensive care unit (Chernivtsi, regional clinical hospital, head doctor Ushakov V.I., head of the Department of Anesthesiology with beds of intensive care Rusnak A.D.). PS was performed in the postoperative period for the patients who had undergone a surgical intervention. On average, one patient had

1-2 sessions. By gender: there were 10 men and 10 women. The structure of nosological forms included both acute cases and exacerbation of chronic diseases: chronic glomerulonephritis (4), chronic pyelonephritis (2), acute glomerulonephritis (2), sepsis (1), peritonitis of various genesis (5), pancreatic necrosis (1), calculus cholecystitis (2), dysentery (1), acute intestinal obstruction (1), obliterating atherosclerosis of the vessels of the lower extremities, a state after surgery (1). Distribution by age: under 30 year- 6; 31-40-year-olds - 2; 41-50-year-olds - 1; 51-60-year-olds - 4; over 60 years - 7 patients. PS was carried out using a routine intermittent (fractional) way. The blood was separated into globular and cellular components by means of gravity. During a session, 800-1200 ml of plasma was obtained, purified and returned to the patient. The process of the PS included the following steps: a) preparing the system with hemosorbent («СКН-4М», «СКН-2К») b) preparing the patient for detoxification (a puncture in both subclavian veins); c) collecting the first portion of blood into "Hemacon -500/300" plastic containers or 500 ml glass bottles; d) centrifuging the blood (centrifuge "РС-6", operating mode - 2 thousand revolutions / minute, time of centrifugation 15 minutes); e) separating plasma from the blood corpuscles by means of a plasma extractor "ПE-01"; e) returning the blood corpuscles and the purified plasma to the patient; e) repeated cycles of collection, purification and return of biological fluids to the patient; g) ending the PS session. The comparison groups involved: 15 patients with the similar nosologies as those mentioned above, who underwent hemosorption (HS) and 5 patients who were detoxified by means of plasmapheresis (PPh). The HS was performed in 2 sessions per patient per day using the generally accepted methodology with a productivity of 80-100 ml / min. During the session, 6.5-9 liters of blood was purified. During a PPh session, up to 900 ml of toxic plasma was removed. An adequate plasma replacement was performed by means of intravenous administration of 400 ml of 10% albumin solution, 450 ml of Rheopolyglucini, 200-250 ml of isotonic sodium chloride solution. Biochemical studies of the total protein and its fractions were carried out on the day of the operation in blood, in plasma, separated from the blood corpuscles, before and after sorption through the hemosorbent column, as well as in the blood after the PS, HS and PPh for 3 consecutive days. Results and discussion. Taking into account the high catabolism in patients with renal insufficiency, a stable level of protein in the blood becomes of particular importance. In the group of patients who underwent PS, the initial index of total protein was on average 61.7 ± 2.7 g/l. It should be noted that after the separation of plasma from the blood corpuscles, the concentration of protein in it was 54.5 ± 3.6 g/l, as 12% of the total protein remains in a plastic container with an erythrocytic mass. After plasma processing, the level of protein decreases and makes up 42.3 ± 2.8 g / l, as 22% of it is bound by hemosorbent of the column. On the first day after the sorption, the index of total protein in it increases slightly to 64.8 ± 1.9 g / l, on the second day this trend persists: 66.5 ± 2.7 g / l, on the third day after the PS - 63, 6 ± 3.1 g / l, exceeding the baseline. Below are data of the dynamics of total protein fractions, which were determined by electrophoresis (Table 1).

Table 1

Dynamics of fractions of total protein (electrophoresis method) influenced by PS (n=20, Mx±σ) in %

Thus, the above findings suggest that there is a tendency to an increase in albumins. At the same time, there is a tendency to a decrease in the globulins α1, α2, β. It can be assumed that the protein-retaining effect in the PS occurs against the background of the stimulating effect of the PS procedure itself and the "reorientation" of the liver on the synthesis of albumins by reducing the synthesis of globulins.

In the group of patients undergoing HS sessions, the total protein in the blood before sorption was 73.4 ± 3.2 g / l, on the first day after the detoxification operation - 59.0 ± 4.5 g / l, on the following days this the index normalized to 76.7 ± 2.3 g / l. This tendency was observed in the future as well. In the group of patients, who used PPh, the initial value of total protein was 65.5 ± 2.8 g / l. In the following days this figure was 64.4 ± 7.2 g / l, and this trend remained.

Conclusion. The protective effect of protein, the cleaning of small doses of plasma, the elimination of the need for substitution plasma correction and the effect on the blood corpuscles in the PS makes it possible to use it in patients with renal failure syndrome, accompanied by anemia and hypoproteinemia.