A Study on the Role of Hemoperfusion in the Paraquat Induced Acute Renal Failure Patients Attending a Tertiary Care Hospital in Eastern India

Abstract

Introduction: Paraquat (PQ), an herbicide, is a very common agent for suicidal, homicidal and accidental poisoning in agriculture based populations. It is easily available, cheap and a highly toxic chemical with high fatality rates in humans. We have studied the use of hemoperfusion in the paraquat induced acute renal failure patients in addition to standard care.

Materials and methods: This is a single centre non blinded study with a 2:1 recruitment in standard (non hemoperfusion) group labeled A and hemoperfusion group labeled B respectively. All patients diagnosed as PQ induced acute renal failure were administered the standard medical care of methylprednisolone 500miligram daily for 3 consecutive days, N acetylcysteine 600 miligram twice daily, and hemodialysis( if serum creatinine was 1.5miligram/deciliter or more/urine output less than 0.5 mililiter per kilogram bodyweight per hour for 6 hours or more /volume overload /metabolic acidosis/hyperkalemia).The baseline characteristics of the patients were studied along with the delay in presentation and the number of sessions of hemodialysis received. Mortality data were collected and analysed.

Results: The baseline characteristics were similar in the two groups. There were 45 patients in group A and 21 patients in group B. Hemoperfusion was given at an average of 2 sessions to 21 patients of group B. None of these 21 patients attended within 4 hours of poisoning.37 patients expired in total. 31 were in the group A and 6 patients were of group B whereas 29 patients survived and were discharged. Of these 14 were in the group A and 15 were in group B. Among the surviving patients, the mean serum creatinine (mean± s.d.) was 2.3690 ± .9370 mg/dl ,the mean number of dialysis sessions (mean± s.d.) was 2.5862 ± 1.1501 and the mean time delay in presentation (mean± s.d.) was 1.7931 ± .4913 (days). Among the patients who expired, the mean serum creatinine (mean± s.d.) was 4.3514 ± 1.8018 mg/dl, the mean number of dialysis sessions (mean± s.d.) was 2.4865 ± 1.9239 and the mean time delay in presentation was 3.0000± 1.1785 (days).

Conclusion: We conclude that charcoal hemoperfusion may improve survival after paraquat ingestion in acute kidney injury patients  presenting between 4 to 40 hours.It has been shown to be effective extracorporeal therapy if given within 4 hours of ingestion. Paraquat has almost 100 percent mortality even with hemodialysis. So hemoperfusion may be tried as a last resort in patients presenting within 40 hours as was seen in our study, but further studies are needed.