Cortisol elimination properties during intermitting hemofiltration in patients with acute renal failure

Introduction

Application of intermitting hemofiltration (IHF) in treatment of patients with acute renal failure (ARF) has significant stress influence and leads to elimination of essential amounts of cortisol and other adaptive hormones.

Materials

Nineteen patients (11 males/eight females) 11–62 years of age with ARF were examined. Forty-six IHF procedures were performed with the mean duration 6.5 ± 0.6 hours; filtration volume 50.2 ± 2.6 (18–85) l; index 1.03 ± 0.8 (0.45–1.53). The filtration rate was 128 ± 9 (27–260) ml/min. The cortisol concentration in the plasma and the filtrate was measured by radioimmune assay.

Results

The cortisol content in the plasma of controls (n = 32) was 334 ± 20 nM/l. At the beginning of the IHF procedures the cortisol concentration in plasma of patients with ARF was 672 ± 83 nM/l (n = 36; P < 0.001). At the end of the procedures the mean plasma cortisol concentration increased to 1197 ± 199 nM/l (P < 0.001). Cortisol concentrations in the effluent were 8303 ± 543, 7993 ± 532 and 8414 ± 416 nM/l at the beginning of the procedure, at the end and in total effluent volume accordingly.

Conclusion

The phenomenon of cortisol 'hyperfiltration' revealed in this study may be explained by filtration of significant amounts of this hormone from the surface of erythrocytes that need to be investigated further.