Effect of Triiodothyronine Administration on the Kidney During Haemorrhagic Shock and Resuscitation

Iosifina Karmaniolou; Konstantinos Lamprou; Chryssoula Staikou; Evangelos Giamarellos-Bourboulis; Kassiani Theodoraki; Apostolos Papalois; Anastasios Mylonas; Nikolaos Orfanos; Vassilios Smyrniotis; Nikolaos Arkadopoulos

doi:10.5152/TJAR.2019.81542

Effect of Triiodothyronine Administration on the Kidney During Haemorrhagic Shock and Resuscitation

Turk J Anaesthesiol Reanim. 2020 Oct;48(5):406-413. doi: 10.5152/TJAR.2019.81542. Epub 2020 Feb 5.

Affiliations

¹ Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK.
² Department of Obstetrics and Gynaecology, Bradford Royal Infirmary, Bradford, UK.
³ 1 Department of Anaesthesia, Aretaieion Hospital, University of Athens Medical School, Athens, Greece.
⁴ 4 Department of Internal Medicine, Attikon Hospital, Medical School, University of Athens, Chaidari, Greece.
⁵ Experimental-Research Center ELPEN Pharmaceuticals, Pikermi, Greece.
⁶ 4 Department of Surgery, Attikon Hospital, Medical School, University of Athens, Chaidari, Greece.

Abstract

Objective: Apoptosis, measured via caspase activity, can be used to assess renal tissue damage in haemorrhagic shock. We investigated whether Triiodothyronine could attenuate apoptosis and protect against haemorrhagic shock-induced renal injury.

Methods: Haemorrhagic shock was induced in swine until the mean arterial pressure (MAP) was 35-40 mmHg for 40 minutes. Animals were randomly assigned to a control group (n=5), Group-F (Fluid resuscitation, n=6), and Group-T3 (Fluid plus Triiodothyronine, n=6). The swine were resuscitated for 1 hour aiming to MAP restoration (±10% from baseline) and were followed up for another 360 minutes. Haemodynamic parameters, fluids, acid-base status, plasma urea nitrogen, creatinine levels and caspase activity in the kidney were measured.

Results: Haemodynamic parameters did not differ significantly amongst the three groups. Group-T3 required less normal saline (Group-T3: 1083±204 mL versus F: 2500±547 mL, p=0.001) and hydroxyethyl starch (Group-T3: 558±102 mL versus F: 916±204 mL, p=0.004) during resuscitation. Additionally, Group-T3 swine experienced less acidosis following haemorrhage/resuscitation with a pH of 7.39 versus a pH of 7.26 in Group-F (p=0.004) at 360 minutes. Urea remained within normal limits in all groups, but creatinine levels were elevated at 6 hours in Group-F as compared to Group-T3 (p=0.019). Apoptosis, assessed by renal caspase-3 activity, was increased in Group-T3 (132±174 pmol minute^-1 g^-1) and reduced in Group-F (32±18 pmol minute^-1 g^-1) as compared to the control group, but without statistical significance (p=0.245 between Group-T3 and Group-F).

Conclusion: Administration of Triiodothyronine in a swine model of haemorrhagic shock seems to interfere with renal cell apoptosis. The exact mechanism needs to be further investigated in future research.

Keywords: Apoptosis; haemorrhagic shock; kidney; resuscitation; triiodothyronine.