Insulin-like growth factor-1 during renal replacement therapy in patients with multiple organ failure

Introduction

Insulin-like growth factor-1 (IGF-1) protein (7650 Da) has a strong anabolic effect. Secretion of IGF-1 fails in a number of pathologies, and this deficit can increase during renal replacement therapy (RRT) procedures.

Materials

Eleven patients (nine males/two females, mean age 49.5 ± 3.7 years) with multiple organ failure (MOF) were examined. APACHE II score was 27.8 ± 0.6. Eight patients had sepsis (72.7%). Ten patients underwent mechanical lung ventilation. Six patients received an inotropic support (54.5%). The mortality rate was 54.5%. Hemoprocessors 'Prisma' (Hospal, France) and 'Aquarius' (Edwards, Germany) were used for RRT. Retrospectively, two groups were selected: Group A (n = 5), treated by hemofiltration (HF), with mean duration of procedures 57.1 ± 6.4 hours, effluent volume 66.0 ± 7.1 l/day; and Group B, treated by hemodiafiltration (HDF), mean duration 49.1 ± 5.7 hours, effluent volume 103.2 ± 3.5 l/day. IGF-1 levels were measured using an ELISA assay (DRG, Germany).

Results

During RRT procedures in Group A the plasma concentration of IGF-1 fluctuated on average from 42.6 to 46.8 ng/ml, in Group B it ranged from 18.1 to 39.8 ng/ml (in healthy men – 150–300 ng/ml). The concentration of IGF-1 in effluent in both groups varied from 14.2 to 25.9 ng/ml and had no statistically significant difference. Elimination of IGF-1 in Group A during HF was 1389.4–1678.9 μg/day and in Group B during HDF was 1741.3–2446.9 μg/day. Clearance IGF-1 was 21.6 ml/min during HF and 56.8 ml/min during HDF due to the large volumes of effluent during the procedures.

Conclusion

A relative deficit in IGF-1 was found in patients with MOF that possibly could be increased by intensive RRT. The preliminary data show the necessity of early usage of this growth factor in patients with MOF.