scholarly journals Precision Fluid Management in Continuous Renal Replacement Therapy

2016 ◽  
Vol 42 (3) ◽  
pp. 266-278 ◽  
Author(s):  
Raghavan Murugan ◽  
Eric Hoste ◽  
Ravindra L. Mehta ◽  
Sara Samoni ◽  
Xiaoqiang Ding ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Fluid Balance ◽  
Fluid Management ◽  
Standards Of Care ◽  
Future Research ◽  
Acid Base ◽  
Plasma Electrolyte ◽  
The Individual

Fluid management during continuous renal replacement therapy (CRRT) in critically ill patients is a dynamic process that encompasses 3 inter-related goals: maintenance of the patency of the CRRT circuit, maintenance of plasma electrolyte and acid-base homeostasis and regulation of patient fluid balance. In this article, we report the consensus recommendations of the 2016 Acute Disease Quality Initiative XVII conference on ‘Precision Fluid Management in CRRT'. We discuss the principles of fluid management, describe various prescription methods to achieve circuit integrity and introduce the concept of integrated fluid balance for tailoring fluid balance to the needs of the individual patient. We suggest that these recommendations could serve to develop the best clinical practice and standards of care for fluid management in patients undergoing CRRT. Finally, we identify and highlight areas of uncertainty in fluid management and set an agenda for future research.

scholarly journals Patient Selection and Timing of Continuous Renal Replacement Therapy

2016 ◽  
Vol 42 (3) ◽  
pp. 224-237 ◽  
Author(s):  
Marlies Ostermann ◽  
Michael Joannidis ◽  
Antonello Pani ◽  
Matteo Floris ◽  
Silvia De Rosa ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Patient Selection ◽  
Kidney Injury ◽  
Practice Variation ◽  
Standards Of Care ◽  
Future Research ◽  
Controversial Topic

When and in whom to initiate continuous renal replacement therapy (CRRT) for acute kidney injury (AKI) remains a highly controversial topic with large practice variation around the world. Even within countries, practice variation exists and recommendations for clinical practice are not specific. In this article, we report the consensus recommendations for timing and patient selection for CRRT - the results of the 2016 Acute Disease Quality Initiative XVII conference on ‘precision CRRT'. We suggest that these recommendations could serve to develop the best clinical practice and standards of care for use of CRRT in patients with AKI. Finally, we identify and highlight the areas of ongoing uncertainty and propose an agenda for future research.

Adjunct Use of Continuous Renal Replacement Therapy with Extracorporeal Membrane Oxygenation Achieves Negative Fluid Balance and Enhances Oxygenation Which Improves Survival in Critically Ill Patients without Kidney Failure

2021 ◽  
pp. 1-8
Author(s):  
Jason M. Thomas ◽  
David N. Dado ◽  
Anthony P. Basel ◽  
James K. Aden ◽  
Sarah B. Thomas ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Extracorporeal Membrane Oxygenation ◽  
Continuous Renal Replacement Therapy ◽  
Renal Dysfunction ◽  
Replacement Therapy ◽  
Fluid Balance ◽  
Fluid Management ◽  
Arterial Oxygen ◽  
Membrane Oxygenation ◽  
Negative Fluid Balance

<b><i>Introduction:</i></b> Fluid overload in extracorporeal membrane oxygenation (ECMO) patients has been associated with increased mortality. Patients receiving ECMO and continuous renal replacement therapy (CRRT) who achieve a negative fluid balance have improved survival. Limited data exist on the use of CRRT solely for fluid management in ECMO patients. <b><i>Methods:</i></b> We performed a single-center retrospective review of 19 adult ECMO patients without significant renal dysfunction who received CRRT for fluid management. These patients were compared to a cohort of propensity-matched controls. <b><i>Results:</i></b> After 72 h, the treatment group had a fluid balance of −3840 mL versus + 425 mL (<i>p</i> ≤ 0.05). This lower fluid balance correlated with survival to discharge (odds ratio 2.54, 95% confidence interval 1.10–5.87). Improvement in the ratio of arterial oxygen content to fraction of inspired oxygen was also significantly higher in the CRRT group (102.4 vs. 0.7, <i>p</i> ≤ 0.05). We did not observe any significant difference in renal outcomes. <b><i>Conclusions:</i></b> The use of CRRT for fluid management is effective and, when resulting in negative fluid balance, improves survival in adult ECMO patients without significant renal dysfunction.

scholarly journals Complications of Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy: An Observational Study

2020 ◽  
Vol 49 (5) ◽  
pp. 567-575 ◽  
Author(s):  
Nathan Axel Bianchi ◽  
Marco Altarelli ◽  
Philippe Eckert ◽  
Antoine Guillaume Schneider
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Real Life ◽  
Regional Citrate Anticoagulation ◽  
Acid Base ◽  
Metabolic Complications ◽  
Citrate Anticoagulation ◽  
Randomized Controlled ◽  
Heparin Anticoagulation

Introduction: Regional citrate anticoagulation (RCA) is the recommended anticoagulation modality for continuous renal replacement therapy (CRRT). RCA was associated with a low rate of complications in randomized controlled trials. However, little is known about the type and rate of complications in real life. We sought to describe complications associated with RCA in comparison with those associated with heparin anticoagulation. Methods: In our institution, RCA has been the default anticoagulation modality for CRRT in all patients without contraindications since 2013. We have retrospectively reviewed all consecutive patients who received CRRT between January and December 2016 in our institution. For each CRRT session, we have assessed circuit duration, administered dose, as well as therapy-associated complications. Those parameters were compared according to whether the circuit was run in continuous veno-venous hemodialysis (CVVHD) mode with RCA or continuous veno-venous hemofiltration (CVVH) mode with heparin anticoagulation. Results: We analyzed 691 CRRT sessions in 121 patients. Of those 400 (57.9%) were performed in CVVHD-RCA mode and 291 (42.1%) in CVVH-Heparin Mode. Compared with ­CVVH-Heparin mode, CVVHD-RCA mode was associated with a longer circuit lifespan (median duration 54.9 interquartile range [IQR 44.6] vs. 15.3 h [IQR 22.4], p < 0.0001). It was associated with a higher rate of metabolic acidosis 77 (20.2%) vs. 18 (7.2%), (p < 0.0001), alkalosis 186 (48.7%) vs. 43 (17.1%), (p= 0.0001), and hypocalcemia 96 (25.07%) vs. 26 events (10.79%), p < 0.0001. However, the majority of these alterations were of benign or moderate severity. Only one possible citrate intoxication was observed. Conclusions: CVVHD-RCA was associated with a much longer circuit life but an increased rate of minor metabolic complications, in particular acid-base derangements. Some of these complications might have been prevented by therapy adaptation. Medical and nursing staff education is of major importance in the implementation of an RCA protocol.

scholarly journals Development of an Accurate Fluid Management System for a Pediatric Continuous Renal Replacement Therapy Device

ASAIO Journal ◽  
2013 ◽  
Vol 59 (3) ◽  
pp. 294-301 ◽  
Author(s):  
Arvind Santhanakrishnan ◽  
Trent T. Nestle ◽  
Brian L. Moore ◽  
Ajit P. Yoganathan ◽  
Matthew L. Paden
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Management System ◽  
Fluid Management

scholarly journals Hyperoncotic Albumin Solution in Continuous Renal Replacement Therapy Patients

2021 ◽  
pp. 1-10
Author(s):  
Zachary O’Brien ◽  
Mark Finnis ◽  
Martin Gallagher ◽  
Rinaldo Bellomo ◽  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Fluid Balance ◽  
Proportional Hazards ◽  
Human Albumin ◽  
Cox Proportional Hazards ◽  
Albumin Solution ◽  
Randomized Evaluation ◽  
Human Albumin Solution

<b><i>Aim:</i></b> The aim of this study was to investigate the association of hyperoncotic (20%) human albumin solution (HAS) with outcomes among critically ill patients receiving continuous renal replacement therapy (RRT). <b><i>Methods:</i></b> Analysis of the Randomized Evaluation of Normal versus Augmented Level (RENAL) RRT trial data. <b><i>Results:</i></b> Of 1,508 patients, 771 (51%) received albumin. Of these, 345 (45%) received 4% HAS only, 155 (20%) received 20% HAS only, and 271 (35%) received both. Patients who received combined 4% and 20% HAS were more severely ill, received more days of RENAL trial therapy and required mechanical ventilation for longer. Mean daily fluid balance was −288 mL (−904 to 261) with 20% HAS only versus 245 mL (−248 to 1,050) with 4% HAS only (<i>p</i> &#x3c; 0.001). On Cox proportional hazards regression, 20% HAS exposure was not associated with greater 90-day mortality (odds ratio 1.12, 95% confidence interval [CI]: 0.77–1.62; <i>p</i> = 0.55) or longer recovery to RRT independence (sub-hazard ratio 1.04, 95% CI: 0.84–1.30; <i>p</i> = 0.70) compared to those who received 4% HAS only. <b><i>Conclusions:</i></b> RENAL trial patients commonly received albumin in varying concentrations. The administration of 20% HAS was associated with a more negative fluid balance but was not independently associated with increased mortality or RRT dependence when compared to 4% HAS only.

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