Optimal Prescriptions of Continuous Renal Replacement Therapy in Neonates with Hyperammonemia

2018 ◽  
Vol 47 (1-3) ◽  
pp. 16-22 ◽  
Author(s):  
Jeong Yeon Kim ◽  
Yeonhee Lee ◽  
Heeyeon Cho
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Therapeutic Option ◽  
Ammonia Level ◽  
Ultrafiltration Rate ◽  
Neurologic Sequelae ◽  
Serum Ammonia Level ◽  
Poor Outcomes ◽  
Serum Ammonia

Background/Aims: The aim of this study was to evaluate patients’ outcomes, determine the prescriptions of continuous renal replacement therapy (CRRT) that effectively reduce serum ammonia levels, and analyze the prognostic factors in neonates with hyperammonemia. Methods: The medical records of 12 Korean neonates with inborn error of metabolism (IEM) who underwent CRRT for hyperammonemia were retrospectively analyzed. Results: All patients received continuous venovenous hemodiafiltration. The median ultrafiltration rate (UFR) at the initiation of CRRT was 2,288.4 mL/h/1.73 m2. The median ammonia level at CRRT initiation was 1,320 µmol/L, and the median time to reduce the initial ammonia level by at least 50% was 12.8 h. The survival rate during hospitalization was 83.3%. There were significant differences between patients with neurologic sequelae and those without poor outcomes in peak serum ammonia level before CRRT and serum ammonia level at CRRT initiation. Conclusion: This study suggested that CRRT could be a therapeutic option for neonates with IEM. However, it is necessary to raise the UFR above 4,000 mL/h/1.73 m2 in patients with high initial ammonia level.

scholarly journals Continuous renal replacement therapy rescued life-threatening capillary leak syndrome in an extremely-low-birth-weight premature: a case report

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Li-Fen Yang ◽  
Jia-Chang Ding ◽  
Ling-Ping Zhu ◽  
Li-Xia Li ◽  
Meng-Qi Duan ◽  
...  
Keyword(s):  
Birth Weight ◽  
Renal Replacement Therapy ◽  
Low Birth Weight ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Therapeutic Option ◽  
Capillary Leak Syndrome ◽  
Extremely Low Birth Weight ◽  
Capillary Leak ◽  
Life Threatening

Abstract Background Capillary leak syndrome (CLS) is a rare disease characterized by profound vascular leakage and presents as a classic triad of hypotension, hypoalbuminemia and hemoconcentration. Severe CLS is mostly induced by sepsis and generally life-threatening in newborns, especially in premature infants. Continuous renal replacement therapy (CRRT) plays an important role of supportive treatment for severe CLS. Unfortunately, CRRT in preterm infants has rarely been well defined. Case presentation We report the case of a 11-day-old girl with CLS caused by sepsis, who was delivered by spontaneous vaginal delivery (SVD) at gestational age of 25 weeks and 4 days, and a birth weight of 0.89 Kilograms(kg). The infant received powerful management consisting of united antibiotics, mechanical ventilation, intravenous albumin and hydroxyethyl starch infusion, vasoactive agents, small doses of glucocorticoids and other supportive treatments. However, the condition rapidly worsened with systemic edema, hypotension, pulmonary exudation, hypoxemia and anuria in about 40 h. Finally, we made great efforts to perform CRRT for her. Fortunately, the condition improved after 82 h’ CRRT, and the newborn was rescued and gradually recovered. Conclusion CRRT is an effective rescue therapeutic option for severe CLS and can be successfully applied even in extremely-low-birth-weight premature.

scholarly journals Continuous renal replacement therapy is associated with reduced serum ammonia levels and mortality in acute liver failure

Hepatology ◽  
2017 ◽  
Vol 67 (2) ◽  
pp. 711-720 ◽  
Author(s):  
Filipe S. Cardoso ◽  
Michelle Gottfried ◽  
Shannan Tujios ◽  
Jody C. Olson ◽  
Constantine J. Karvellas ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Serum Ammonia

scholarly journals Net ultrafiltration rate and its impact on mortality in patients with acute kidney injury receiving continuous renal replacement therapy

2019 ◽  
Author(s):  
Shahrzad Tehranian ◽  
Khaled Shawwa ◽  
Kianoush B Kashani
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
High Intensity ◽  
Kidney Injury ◽  
Ultrafiltration Rate ◽  
Baseline Serum ◽  
Fluid Removal ◽  
The Impact

Abstract Background Fluid overload, a critical consequence of acute kidney injury (AKI), is associated with worse outcomes. The optimal fluid removal rate per day during continuous renal replacement therapy (CRRT) is unknown. The purpose of this study is to evaluate the impact of the ultrafiltration rate on mortality in critically ill patients with AKI receiving CRRT. Methods This was a retrospective cohort study where we reviewed 1398 patients with AKI who received CRRT between December 2006 and November 2015 at the Mayo Clinic, Rochester, MN, USA. The net ultrafiltration rate (UFNET) was categorized into low- and high-intensity groups (<35 and ≥35 mL/kg/day, respectively). The impact of different UFNET intensities on 30-day mortality was assessed using logistic regression after adjusting for age, sex, body mass index, fluid balance from intensive care unit (ICU) admission to CRRT initiation, Acute Physiologic Assessment and Chronic Health Evaluation III and sequential organ failure assessment scores, baseline serum creatinine, ICU day at CRRT initiation, Charlson comorbidity index, CRRT duration and need of mechanical ventilation. Results The mean ± SD age was 62 ± 15 years, and 827 (59%) were male. There were 696 patients (49.7%) in the low- and 702 (50.2%) in the high-intensity group. Thirty-day mortality was 755 (54%). There were 420 (60%) deaths in the low-, and 335 (48%) in the high-intensity group (P < 0.001). UFNET ≥35 mL/kg/day remained independently associated with lower 30-day mortality (adjusted odds ratio = 0.47, 95% confidence interval 0.37–0.59; P < 0.001) compared with <35 mL/kg/day. Conclusions More intensive fluid removal, UFNET ≥35 mL/kg/day, among AKI patients receiving CRRT is associated with lower mortality. Future prospective studies are required to confirm this finding.

Predictors of Hypophosphatemia and Outcomes during Continuous Renal Replacement Therapy

2020 ◽  
Vol 49 (6) ◽  
pp. 700-707 ◽  
Author(s):  
Rachel Jenkins Hendrix ◽  
M. Colleen Hastings ◽  
Michael Samarin ◽  
Joanna Q. Hudson
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Patient Outcomes ◽  
Kidney Injury ◽  
Discharge Duration ◽  
Poor Outcomes ◽  
Stage Renal Disease ◽  
End Stage ◽  
Mean Time

<b><i>Introduction:</i></b> Hypophosphatemia occurs in up to 80% of patients undergoing continuous renal replacement therapy (CRRT) and has been associated with poor outcomes. Whether preemptive phosphate supplementation is warranted in select patients has not been adequately explored. This single-center, retrospective cohort study evaluates predictors of hypophosphatemia and characterizes treatment approaches in adult patients undergoing at least 12 h of CRRT. <b><i>Methods:</i></b> Patients were divided into 2 groups based on the presence or absence of hypophosphatemia as defined by serum phosphorus &#x3c;2.5 mg/dL. Select laboratory values at baseline and during CRRT, medications and nutritional sources affecting phosphorus, and CRRT parameters were compared. Patient outcomes including resolution of acute kidney injury (AKI), freedom from renal replacement therapy at hospital discharge, duration of intensive care unit (ICU) and hospital stay, duration of mechanical ventilation, and ICU mortality were evaluated. <b><i>Results:</i></b> Seventy-two patients were included. The group was 43% female and 51% African American. CRRT was ordered for AKI in 83% and for end-stage renal disease in 15%. Hypophosphatemia occurred in 45 patients (63%). Mean time to development of hypophosphatemia was 34 ± 22 h. Patients who developed hypophosphatemia received a longer duration of CRRT (<i>p</i> = 0.001), were more likely to have a diet ordered (<i>p</i> = 0.005), less likely to have received calcium infusions (<i>p</i> = 0.045), and had lower phosphorus (<i>p</i> = 0.017) and potassium levels (<i>p</i> = 0.038) and higher calcium levels at baseline (<i>p</i> = 0.048). Development of hypophosphatemia was associated with an increased duration of ICU stay (<i>p</i> = 0.014) but not with the other patient outcomes evaluated. Twenty-seven of the 45 patients (60%) who developed hypophosphatemia received phosphorus supplementation with near equal use of intravenous, oral, and combination routes. Only 17 patients (38%) achieved resolution of hypophosphatemia while on CRRT. <b><i>Conclusion:</i></b> Hypophosphatemia is common, difficult to correct, and contributes to longer ICU stays in patients requiring CRRT. A preemptive approach to address hypophosphatemia including aggressive supplementation strategies to correct phosphorus is warranted in patients requiring CRRT.

scholarly journals Factors associated with poor outcomes of continuous renal replacement therapy

PLoS ONE ◽  
2017 ◽  
Vol 12 (5) ◽  
pp. e0177759 ◽  
Author(s):  
Chih-Chin Kao ◽  
Ju-Yeh Yang ◽  
Likwang Chen ◽  
Chia-Ter Chao ◽  
Yu-Sen Peng ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Factors Associated ◽  
Poor Outcomes
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