scholarly journals Extracorporeal Ammonia Clearance for Hyperammonemia in Critically Ill Patients: A Scoping Review

2020 ◽  
pp. 1-9
Author(s):  
Thummaporn Naorungroj ◽  
Fumitaka Yanase ◽  
Glenn M. Eastwood ◽  
Ian Baldwin ◽  
Rinaldo Bellomo
Keyword(s):  
Blood Flow ◽  
Flow Rate ◽  
Case Reports ◽  
Blood Flow Rate ◽  
Intermittent Hemodialysis ◽  
Eligibility Criteria ◽  
Inborn Errors ◽  
Extracorporeal Treatment ◽  
Effluent Flow Rate ◽  
Threatening Condition

<b><i>Introduction:</i></b> Hyperammonemia is a life-threatening condition. However, clearance of ammonia via extracorporeal treatment has not been systematically evaluated. <b><i>Methods:</i></b> We searched EMBASE and MEDLINE databases. We included all publications reporting ammonia clearance by extracorporeal treatment in adult and pediatric patients with clearance estimated by direct dialysate ammonia measurement or calculated by formula. Two reviewers screened and extracted data independently. <b><i>Results:</i></b> We found 1,770 articles with 312 appropriate for assessment and 28 studies meeting eligibility criteria. Most of the studies were case reports. Hyperammonemia was typically secondary to inborn errors of metabolisms in children and to liver failure in adult patients. Ammonia clearance was most commonly reported during continuous renal replacement therapy (CRRT) and appeared to vary markedly from &#x3c;5 mL/min/m<sup>2</sup> to &#x3e;250 mL/min/m<sup>2</sup>. When measured during intermittent hemodialysis (IHD), clearance was highest and correlated with blood flow rate (<i>R</i><sup>2</sup> = 0.853; <i>p</i> &#x3c; 0.001). When measured during CRRT, ammonia clearance could be substantial and correlated with effluent flow rate (EFR; <i>R</i><sup>2</sup> = 0.584; <i>p</i> &#x3c; 0.001). Neither correlated with ammonia reduction. Peritoneal dialysis (PD) achieved minimal clearance, and other extracorporeal techniques were rarely studied. <b><i>Conclusions:</i></b> Extracorporeal ammonia clearance varies widely with sometimes implausible values. Treatment modality, blood flow, and EFR, however, appear to affect such clearance with IHD achieving the highest values, PD achieving minimal values, and CRRT achieving substantial values especially at high EFRs. The role of other techniques remains unclear. These findings can help inform practice and future studies.

Ceftolozane/tazobactam exposure in critically ill patients undergoing continuous renal replacement therapy: a PK/PD approach to tailor dosing

2020 ◽  
Vol 76 (1) ◽  
pp. 199-205 ◽  
Author(s):  
Milo Gatti ◽  
Maddalena Giannella ◽  
Emanuel Raschi ◽  
Pierluigi Viale ◽  
Fabrizio De Ponti
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Flow Rate ◽  
Case Reports ◽  
Blood Flow Rate ◽  
Pubmed Database ◽  
Effluent Flow Rate ◽  
Dosing Regimens ◽  
Trough Concentrations

Abstract Objectives To investigate the influence of continuous renal replacement therapy (CRRT) intensity on the clearance of ceftolozane/tazobactam in critical care patients, and to evaluate if the reported doses would achieve an optimal pharmacokinetic/pharmacodynamic (PK/PD) target against Pseudomonas aeruginosa exhibiting different MICs. Methods The MEDLINE–PubMed database was searched from inception to January 2020 to retrieve observational studies or case reports investigating the PK behaviour of ceftolozane/tazobactam during CRRT. Relevant CRRT settings and PK variables were extracted, and the influence of CRRT intensity on ceftolozane/tazobactam total clearance (CLtot) was determined by simple linear regression. The optimal PK/PD target for the reported doses was deemed to be achieved when ceftolozane trough concentrations (Cmin) were above the MIC (less intensive target) or four times the MIC (intensive target) for P. aeruginosa. Results Data from six studies including 11 patients (mean age 56.6 years) were analysed. Mean blood flow rate and effluent flow rate were 161.8 mL/min and 2383.4 mL/h, respectively. Ceftolozane Cmin ranged from 25.8 to 79.4 mg/L. A significant correlation was found for ceftolozane CLtot and effluent flow rate (P = 0.027). The intensive PK/PD target was achieved by 100% and 50% of the reported doses for MIC, respectively, up to 4 and 8 mg/L. Conclusions A significant correlation between effluent flow rate and ceftolozane clearance during CRRT could be identified. Higher dosing regimens coupled with continuous/extended infusion may be required in the case of higher CRRT intensity, deep-seated infections or poorly susceptible isolates. Larger studies assessing ceftolozane PK in different CRRT settings are warranted.

The Effect of Furosemide on the Intrarenal Blood Flow Distribution in the Dog

1972 ◽  
Vol 50 (8) ◽  
pp. 774-783 ◽  
Author(s):  
Serge Carrière ◽  
Michel Desrosiers ◽  
Jacques Friborg ◽  
Michèle Gagnan Brunette
Keyword(s):  
Blood Flow ◽  
Flow Rate ◽  
Urine Volume ◽  
Flow Distribution ◽  
Blood Flow Rate ◽  
Initial Distribution ◽  
Blood Flow Distribution ◽  
Intrarenal Blood Flow ◽  
Femoral Blood ◽  
Furosemide Administration

Furosemide (40 μg/min) was perfused directly into the renal artery of dogs in whom the femoral blood pressure was reduced (80 mm Hg) by aortic clamping above the renal arteries. This maneuver, which does not influence the intrarenal blood flow distribution, produced significant decreases of the urine volume, natriuresis, Ccreat, and CPAH, and prevented the marked diuresis normally produced by furosemide. Therefore the chances that systemic physiological changes occurred, secondary to large fluid movements, were minimized. In those conditions, however, furosemide produced a significant increase of the urine output and sodium excretion in the experimental kidney whereas Ccreat and CPAH were not affected. The outer cortical blood flow rate (ml/100 g-min) was modified neither by aortic constriction (562 ± 68 versus 569 ± 83) nor by the subsequent administration of furosemide (424 ± 70). The blood flow rate of the outer medulla in these three conditions remained unchanged (147 ± 52 versus 171 ± 44 versus 159 ± 54). The initial distribution of the radioactivity in each compartment remained comparable in the three conditions. In parallel with the results from the krypton-85 disappearance curves, the autoradiograms, silicone rubber casts, and EPAH did not suggest any change in the renal blood flow distribution secondary to furosemide administration.

The Effect of Hematocrit on the Clearance of Small Molecules during Hemodialysis

1983 ◽  
Vol 6 (3) ◽  
pp. 127-130 ◽  
Author(s):  
C. Woffindin ◽  
N.A. Hoenich ◽  
D.N.S. Kerr
Keyword(s):  
Blood Flow ◽  
Regression Analysis ◽  
Small Molecules ◽  
Flat Plate ◽  
Flow Rate ◽  
Distribution Curve ◽  
Blood Flow Rate ◽  
Hollow Fibre ◽  
Urea Clearance ◽  
Flow Rates

Data collected during the evaluation of a series of hemodialysers were analysed to see the effect of hematocrit on the clearance of urea and creatinine. All evaluations were performed on patients with a range of hematocrits with a mean close to 20%. The urea clearance of those in the upper half of the distribution curve (mean hematocrit 29.4%) was not significantly different from that of patients in the lower half of the distribution curve (mean hematocrit 16.9%) whether the clearance was studied at high or low blood flow rates and with hollow fibre or flat plate disposable hemodialysers. Likewise, there was no correlation between hematocrit and urea clearance by regression analysis. In contrast, the clearance of creatinine was affected by hematocrit being greater at lower hematocrit values. This difference was independent of blood flow rate and dialyser type and was confirmed by regression analysis.

Anoxia and adenosine induce increased cerebral blood flow rate in crucian carp

1994 ◽  
Vol 267 (2) ◽  
pp. R590-R595 ◽  
Author(s):  
G. E. Nilsson ◽  
P. Hylland ◽  
C. O. Lofman
Keyword(s):  
Blood Flow ◽  
Flow Rate ◽  
Crucian Carp ◽  
Blood Flow Rate ◽  
Fold Increase ◽  
Liver Glycogen ◽  
Glycolytic Flux ◽  
Brain Blood Flow ◽  
Atp Production ◽  
The Brain

The crucian carp (Carassius carassius) has the rare ability to survive prolonged anoxia, indicating an extraordinary capacity for glycolytic ATP production, especially in a highly energy-consuming organ like the brain. For the brain to be able to increase its glycolytic flux during anoxia and profit from the large liver glycogen store, an increased glucose delivery from the blood would be expected. Nevertheless, the effect of anoxia on brain blood flow in crucian carp has never been studied previously. We have used epireflection microscopy to directly observe and measure blood flow rate on the brain surface (optic lobes) during normoxia and anoxia in crucian carp. We have also examined the possibility that adenosine participates in the regulation of brain blood flow rate in crucian carp. The results showed a 2.16-fold increase in brain blood flow rate during anoxia. A similar increase was seen after topical application of adenosine during normoxia, while adenosine was without effect during anoxia. Moreover, superfusing the brain with the adenosine receptor blocker aminophylline inhibited the effect of anoxia on brain blood flow rate, clearly suggesting a mediatory role of adenosine in the anoxia-induced increase in brain blood flow rate.

scholarly journals Patient-specific computational haemodynamics associated with surgical creation of an arteriovenous fistula

2021 ◽  
Author(s):  
George Hyde-Linaker ◽  
Pauline Hall Barrientos ◽  
Sokratis Stoumpos ◽  
Asimina Kazakidi
Keyword(s):  
Blood Flow ◽  
Flow Rate ◽  
Disease Patient ◽  
Blood Flow Rate ◽  
Fold Increase ◽  
Transitional Flow ◽  
Patient Specific ◽  
Venous Anastomosis ◽  
End Stage

Abstract Despite arteriovenous fistulae (AVF) being the preferred vascular access for haemodialysis, high primary failure rates (30-70%) and low one-year patency rates (40-70%) hamper their use. The haemodynamics within the vessels of the fistula change significantly following surgical creation of the anastomosis and can be a surrogate of AVF success or failure. Computational fluid dynamics (CFD) can crucially predict AVF outcomes through robust analysis of a fistula’s haemodynamic patterns, which is impractical in-vivo. We present a proof-of-concept CFD framework for characterising the AVF blood flow prior and following surgical creation of a successful left radiocephalic AVF in a 20-year-old end-stage kidney disease patient. The reconstructed vasculature was generated utilising multiple contrast-enhanced magnetic resonance imaging (MRI) datasets. Large eddy simulations were conducted for establishing the extent of arterial and venous remodelling. Following anastomosis creation, a significant 2-3-fold increase in blood flow rate was induced downstream of the left subclavian artery. This was validated through comparison with post-AVF patient-specific phase-contrast data. The increased flow rate yielded an increase in time-averaged wall shear stress (TAWSS), a key marker of adaptive vascular remodelling. We have demonstrated TAWSS and oscillatory shear distributions of the transitional-flow in the venous anastomosis are predictive of AVF remodelling.

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