Can Cistanche help the Acute Kidney Injury?
Mar 11, 2022
Response to "Are fluids resuscitation the "Keyser Soze" of acute kidney injury in trauma patients?"
Contact: joanna.jia@wecistanche.com / WhatsApp: 008618081934791
AnatoleHarrois1*, BenjaminSoyer1, TobiasGauss2, SophieHamada1, MathieuRaux3, JacquesDuranteau1 and for the Traumabase® Group See related letter by Jamme and Salem.
Keywords: cistanche, acute kidney injury, trauma patients, fluids resuscitation.
We appreciate the interest expressed by Dr. Jamme and Ben Hadj Salem in our study recently published in critical care reporting the prevalence and the risk factors of acute kidney injury in a multicentre cohort of 3111 trauma patients [1]. The issue they raised was the lack of data on fluid resuscitation, especially regarding the number of crystalloids and colloids. We share with the authors the view that the choice of fluid is a critical issue to prevent acute kidney injury in trauma patients. Indeed, recent studies have called into question the safety of colloids [2] in trauma patients as well as the safety of NaCl 0.9% in ICU patients [3]. Our database provides data on prehospital fluid resuscitation for the whole study cohort as well as data on 24-h fluid resuscitation for hemorrhagic shock patients (n = 355, 11%).
Nineteen percent of the 3111 study patients received colloids (median volume of 500 mL [IQR 500–750]) while 94% of the 3111 study patients received crystalloids (median volume of 500 mL [IQR 500–1000]) during the prehospital period. When the volume of colloids or crystalloids administered in the prehospital setting was forced into the predictive model of acute kidney injury (all stages of RIFLE classification), odds ratios were respectively (per 1000 mL of solution) 1.34 (CI 0.85–2.12, p = 0.21) and
1.11 (CI 0.84–1.45, p = 0.47). Thus, prehospital fluid resuscitation does not provide additional value to early predict acute kidney injury. The longer period of exposure might be worth considering to capture the potential nephrotoxic effect of fluid on renal function; however, as our main objective was to early predict acute kidney injury after trauma, we believe it would make the model less relevant.
Eighty-seven percent of hemorrhagic shock patients received colloids over the first 24 h of care (median volume of 1000 mL [IQR 500–2000]). Though only 9.6% of them received a dose higher than 33 mL/kg, we cannot rule out that colloids caused renal toxicity in our study cohort. In the meantime, patients received a median volume of 3500 mL [IQR 2000–6000] of crystalloids. Our database does not distinguish the various types of crystalloids and provides no data on hyperchloremia to indirectly assess the administered volume of NaCl 0.9%. However, at the time of the study, the three centers were using, though not exclusively, NaCl 0.9% for fluid resuscitation. Given a large amount of administered crystalloids in hemorrhagic shock patients, we cannot exclude that chloride-rich fluids worsened renal aggression.
The key point is to improve kidney function and help acute kidney injury
As shown in Fig. 1, colloid use has declined over the last few years while crystalloids remain the cornerstone for fluid resuscitation in trauma patients. To prevent nephrotoxicity related to NaCl 0.9%, isotonic-balanced crystalloids have been proposed for fluid resuscitation, including for patients with traumatic brain injury [4]. However, further studies are necessary to assess if this practice translates to better outcomes in trauma patients. We are about to start such a study (NCT03630224).
Acknowledgments
Collaborating author names of the TRAUMABASE Group: Catherine PaugamBurtz, MD, PhD (Université Denis Diderot and Beaujon University Hospital, Hôpitaux Universitaires Paris Nord-Val-De-Seine, Clichy, AP-HP, France); Romain Pirracchio, MD, PhD (Université Paris Descartes and Department of Anaesthesiology and Critical Care, Hôpital Européen Georges Pompidou, APHP, Paris, France); Anne Godier, MD, PhD (Université Paris Descartes and Department of Anaesthesiology and Critical Care, Hôpital Européen Georges Pompidou, APHP, Paris, France); Sylvain Ausset, MD (Anaesthesiology and Critical Care, Hôpital d'instruction des armées Percy, Clamart, France) ; Eric Meaudre, MD (Department of Anesthesiology and Intensive Care, Military Hospital, Hôpital d'Instruction des Armées Sainte-Anne) ; Thomas Geeraerts, MD, PhD (Department of Anesthesia and Critical Care, University Hospital of Toulouse, University Toulouse 3-Paul Sabatier, Toulouse, France) ; Nathalie Delhaye, Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Département d'Anesthésie Réanimation, Paris, France ; Bernard Vigué, Université paris Sud, Université Paris Saclay, Department of Anesthesiology and Critical Care, Assistance Publique-Hôpitaux de Paris (APHP), Bicêtre Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre, France.
Cistanche can avoid acute kidney injury.
Funding
No source of funding
Availability of data and materials
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request
Authors' contributions
AH, and JD contributed to the study concept and design. AH, BS, SH, MR, and TG contributed to the data acquisition. AH, SH, BS, and JD contributed to the data analysis. AH, BS, SH, MR, TG, and JD contributed to the data interpretation. AH, BS and JD contributed to the drafting. AH, BS, SH, MR, TG, and JD contributed to the critical revision. All authors read and approved the final manuscript.
Ethics approval and consent to participate
The TraumaBase® group obtained approval for this study, including waived informed consent from the Institutional Review Board (Comité pour la Protection des Personnes, Paris VI-Pitié-Salpêtrière, France). The database was approved by the Advisory Committee for Information Processing in Health Research (Comité Consultatif sur le Traitement de l'Information en matière de Recherche dans le Domaine de la Santé), and the French National Commission on Computing and Liberty (Commission Nationale Informatique et Liberté).
Consent for publication
The manuscript does not contain any person's data in any form.
Competing interests
The authors declare that they have no competing interests.
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Author details 1 Department of Anesthesiology and Critical Care, Bicêtre Hôpitaux Universitaires Paris Sud, Université Paris Saclay, AP-HP, 78 Rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France. 2 Department of Anesthesiology and Critical Care, AP-HP, Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, 100 Avenue du Général Leclerc, 92110 Clichy, France. 3 Department of Anesthesiology and Critical Care, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Sorbonne Université, AP-HP, 47-83 Boulevard de l'Hôpital, 75013 Paris, France. Received: 23 January 2019 Accepted: 5 February 2019
Published online 19 Feb 2019
As a well-known Chinese traditional medicine, cistanche is widely used for acute kidney injury, chronic kidney diseases, and improvement of kidney functions.
References
1. Harris A, Soyer B, Gauss T, Hamada S, Raux M, Duranteau J, et al. Prevalence and risk factors for acute kidney injury among trauma patients: a multicenter cohort study. Crit Care. 2018;22:344.
2. Qureshi SH, Rizvi SI, Patel NN, Murphy GJ. Meta-analysis of colloids versus crystalloids in critically ill, trauma and surgical patients. Br J Surg. 2016;103:14–26.
3. Semler MW, Self WH, Wanderer JP, Ehrenfeld JM, Wang L, Byrne DW, et al. Balanced crystalloids versus saline in critically ill adults. N Engl J Med. 2018;378:829–39.
4. Roquilly A, Loutrel O, Cinotti R, Rosenzweig E, Fleet L, Mahe PJ, et al. Balanced versus chloride-rich solutions for fluid resuscitation in brain-injured patients: a randomized double-blind pilot study. Crit Care. 2013;17:R77.
