SP238STEWART’S APPROACH FOR ACIDOSIS DETECTION IN ACUTE KIDNEY INJURY PATIENTS UNDERGOING CONTINUOUS RENAL REPLACEMENT THERAPIES

Introduction: Definition, prevention, and management of acute kidney injury (AKI) and the optimal prescription and delivery of renal replacement therapy (RRT) are currently matters of ongoing discussion. Due to the lack of definitive published literature, a wide gap might exist between routine clinical practice and available recommendations. The aim of this survey was to explore the clinical approach to AKI and RRT in a broad population of nephrologists and intensivists participating in the 36th International course on AKI and Continuous RRT (CRRT), held in Vicenza in June 2018. The responses of the 369 participants to a questionnaire on several aspects of critical care nephrology were analyzed and detailed. Results: Approximately 450 participants attended the course; of these, 369 (82%) correctly filled the survey forms. According to the reported answers, the average incidence of AKI in respondents’ intensive care units (ICU) was 26.8% (SD ±15.99) and AKI requiring dialysis was 13% (SD ±29.7). Sixty-four percent of participants defined AKI as an increase in serum creatinine (SCr) up to 0.99 mg/dL (SD ±0.88 mg/dL); 2.4% defined AKI as an increase in urea nitrogen up to 83.6 mg/dL (SD ±36.6 mg/dL); 33.6% defined AKI as decreased urine output to less than 1 mL/kg/h (SD ±0.6 mL/kg/h). The most common answer to classify AKI was Kidney Disease: Improving Global Outcomes (KDIGO; 41%) criteria. Most of the participants (25%) think novel biomarkers should replace SCr on daily routine laboratory screening, and Cystatin C was the most commonly used biomarker (19%). The use of diuretics in AKI patients was high (62%). Continuous RRT (59%) and heparin anticoagulation (42%) appeared to be the most common approaches in ICU. Conclusions: KDIGO appeared to be widely applied. The use of novel biomarkers has also emerged in recent years even if some consistent cost-benefit evidence is still lacking. There is a trend of increased awareness about AKI and extracorporeal treatments seem to be increasingly applied, when compared to previous surveys. Educational efforts and AKI management standardization still appear to be a fundamental aspect to harmonize therapeutic approaches and improve patients’ outcomes.

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Continuous Renal Replacement Therapies for Acute Kidney Injury

Handbook of Dialysis Therapy ◽

10.1016/b978-0-323-39154-2.00028-x ◽

2017 ◽

pp. 356-379.e7 ◽

Cited By ~ 1

Author(s):

Celina Denise Cepeda ◽

Piyush Mathur ◽

Ravindra L. Mehta

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Renal Replacement Therapies ◽

Continuous Renal Replacement Therapies

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Timing of continuous renal replacement therapies in acute kidney injury patients after cardiac surgery

Intensive Care Medicine Experimental ◽

10.1186/2197-425x-3-s1-a261 ◽

2015 ◽

Vol 3 (S1) ◽

Author(s):

P Cardenas Campos ◽

J Sabater Riera ◽

G Moreno Gonzalez ◽

VF Corral Velez ◽

JM Vazquez Reveron ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Kidney Injury ◽

Renal Replacement Therapies ◽

Continuous Renal Replacement Therapies

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Disease Severity Determines Timing of Initiating Continuous Renal Replacement Therapies: A Systematic Review and Meta-Analysis

Frontiers in Medicine ◽

10.3389/fmed.2021.580144 ◽

2021 ◽

Vol 8 ◽

Author(s):

Zi-Jing Xia ◽

Lin-ye He ◽

Shu-Yue Pan ◽

Rui-Juan Cheng ◽

Qiu-Ping Zhang ◽

...

Keyword(s):

Acute Kidney Injury ◽

Hospital Mortality ◽

Disease Severity ◽

Kidney Injury ◽

Significant Benefit ◽

Renal Recovery ◽

Cochrane Library ◽

Term Survival ◽

Renal Replacement Therapies ◽

Continuous Renal Replacement Therapies

Background: Timing of initiating continuous renal replacement therapies (CRRTs) among the patients with acute kidney injury (AKI) in intensive care units (ICU) has been discussed over decades, but the definition of early and late CRRT initiation is still unclear.Methods: The English language randomized controlled trials (RCTs) and cohort studies were searched through MEDLINE, EMBASE, and Cochrane Library on July 19, 2019, by the two researchers independently. The study characteristics; early and late definitions; outcomes, such as all-cause, in-hospital, 28- or 30-, 60-, 90-day mortality; and renal recovery were extracted from the 18 eligible studies. Pooled relative risk ratios (RRs) and 95% CIs were estimated with the fixed effects model and random effects model as appropriate. This study is registered with PROSPERO (CRD 42020158653).Results: Eighteen studies including 3,914 patients showed benefit in earlier CRRT (n = 1,882) over later CRRT (n = 2,032) in all-cause mortality (RR 0.78, 95% CI 0.66–0.92), in-hospital mortality (RR 0.81, 95% CI 0.67–0.99), and 28- or 30-day mortality (RR 0.81, 95% CI 0.74–0.88), but in 60- and 90-day mortalities, no significant benefit was observed. The subgroup analysis showed significant benefit in the disease-severity-based subgroups on early CRRT initiation in terms of in-hospital mortality and 28- or 30-day mortality rather than the time-based subgroups. Moreover, early CRRT was found to have beneficial effects on renal recovery after CRRT (RR 1.21, 95% CI 1.01–1.45).Conclusions: Overall, compared with late CRRT, early CRRT is beneficial for short-term survival and renal recovery, especially when the timing was defined based on the disease severity. CRRT initiation on Acute Kidney Injury Network (AKIN) stage 1 or Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE)-Risk or less may lead to a better prognosis.

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Peritoneal Dialysis in Renal Replacement Therapy for Patients with Acute Kidney Injury

International Journal of Nephrology ◽

10.4061/2011/739794 ◽

2011 ◽

Vol 2011 ◽

pp. 1-10 ◽

Cited By ~ 16

Author(s):

Naheed Ansari

Keyword(s):

Acute Kidney Injury ◽

Developing Countries ◽

Peritoneal Dialysis ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Kidney Injury ◽

Hemodynamic Instability ◽

Renal Replacement Therapies ◽

Continuous Renal Replacement Therapies ◽

Trained Staff

Peritoneal dialysis (PD) was the first modality used for renal replacement therapy (RRT) of patients with acute kidney injury (AKI) because of its inherent advantages as compared to Hemodialysis. It provides the nephrologist with nonvascular alternative for renal replacement therapy. It is an inexpensive modality in developing countries and does not require highly trained staff or a complex apparatus. Systemic anticoagulation is not needed, and it can be easily initiated. It can be used as continuous or intermittent procedure and, due to slow fluid and solute removal, helps maintain hemodynamic stability especially in patients admitted to the intensive care unit. PD has been successfully used in AKI involving patients with hemodynamic instability, those at risk of bleeding, and infants and children with AKI or circulatory failure. Newer continuous renal replacement therapies (CRRTs) are being increasingly used in renal replacement therapy of AKI with less use of PD. Results of studies comparing newer modalities of CRRT versus acute peritoneal dialysis have been conflicting. PD is the modality of choice in renal replacement therapy in pediatric patients and in patients with AKI in developing countries.

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High Cut-off Membranes in Acute Kidney Injury and Continuous Renal Replacement Therapy

The International Journal of Artificial Organs ◽

10.5301/ijao.5000662 ◽

2017 ◽

Vol 40 (12) ◽

pp. 657-664 ◽

Cited By ~ 5

Author(s):

Zaccaria Ricci ◽

Stefano Romagnoli ◽

Claudio Ronco

Keyword(s):

Acute Kidney Injury ◽

New Technologies ◽

Wide Spectrum ◽

Kidney Injury ◽

Wide Distribution ◽

Renal Replacement Therapies ◽

Clinical Literature ◽

Continuous Renal Replacement Therapies ◽

Innovative Biomaterials ◽

New Generation

Innovation in continuous renal replacement therapies (CRRT) utilized to treat acute kidney injury (AKI) and sepsis, has brought new machines and techniques. Part of these new advances are due to the availability of innovative biomaterials and the construction of membranes with larger pores and wide distribution of pore sizes. This includes the creation of a new generation of high cut-off membranes whose utilization in clinical practice is promising for the wide spectrum of solutes that are removed during extracorporeal therapies. However, the enlargement of pore diameters brings some loss of albumin during treatment and this effect is still under evaluation, since there is a possibility that this is detrimental for the patient. A thorough review of the available clinical literature is reported in this paper with a reappraisal of the potential application of these new technologies.

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Intermittent hemodiafiltration as a down-step transition therapy in patients with acute kidney injury admitted to intensive care unit who initially underwent continuous venovenous hemodiafiltration

The International Journal of Artificial Organs ◽

10.1177/0391398820952801 ◽

2020 ◽

pp. 039139882095280

Author(s):

Patricia Faria Scherer ◽

Ilson Jorge Iizuka ◽

Adriano Luiz Ammirati ◽

Marisa Petrucelli Doher ◽

Thais Nemoto Matsui ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Serum Levels ◽

Serious Illness ◽

Prospective Pilot Study ◽

Continuous Venovenous Hemodiafiltration ◽

Renal Replacement Therapies ◽

Continuous Renal Replacement Therapies ◽

Step Transition ◽

Urea Reduction Ratio

Background/Aims: Continuous renal replacement therapies (CRRT) are initially employed in patients with acute kidney injury (AKI) in ICU setting. After the period of serious illness, hemodialysis is usually used as a mode of transition from CRRT. Intermittent hemodiafiltration (HDF) is not commonly applied in this scenario. Objectives: To evaluate the feasibility of using HDF as transition therapy after CVVHDF in critically patients with AKI. Methods: An observational and prospective pilot study was conducted in ICU patients with dialysis-requiring AKI. Patients were initially treated with CVVHDF and, after medical improvement, those who still needed renal replacement therapy were switched to HDF treatment. Results: Ten Patients underwent 53 HDF sessions (mean of 5.3 sessions/patient). The main cause of renal dysfunction was sepsis ( N = 7; 70%). The APACHE II mean score was 27.6 ± 6.9. During HDF treatment, the urea reduction ratio was 64.5 ± 7.5%, for β-2 microglobulin serum levels the percentage of decrease was 42.0 ± 7.8%, and for Cystatin C was 36.2 ± 6.9%. Five episodes of arterial hypotension occurred (9.4% of sessions). There were 20 episodes of electrolytic disturbance (37.7% of sessions), mainly hypophosphatemia. No pyrogenic or suggestive episode of bacteremia was observed. Conclusion: Hemodiafiltration was safe and efficient to treat critically ill patients with acute kidney injury during the transition phase from continuous to intermittent dialysis modality. Special attention should be paid regarding the occurrence of electrolytic disturbance, mainly hypophosphatemia.

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Acute kidney injury (AKI)

Oxford Desk Reference Nephrology ◽

10.1093/med/9780198777182.003.0012 ◽

2021 ◽

pp. 490-525

Keyword(s):

Acute Kidney Injury ◽

Kidney Function ◽

Low Income ◽

Urine Output ◽

Incidental Finding ◽

Hospital Setting ◽

Kidney Injury ◽

Electrolyte Disorders ◽

Severe Condition ◽

Renal Replacement Therapies

Acute kidney injury (AKI) can generally be considered as sudden reduction in kidney function occurring over hours to days, and is commonly but not always associated with a reduction in urine output. Its definition was based on rises in serum creatinine and reductions in urine output criteria. Its incidence, prevalence, and aetiology vary according to the country/region profile (low income, high income, tropical, etc.), age (children, adult, or elderly), and clinical setting (outpatients versus inpatient, hospital versus intensive care unit). The incidence of AKI is increasing in the hospital setting, and is more common with increasing age, male sex, pre-existing CKD, and comorbidity (congestive cardiac failure, diabetes, hypertension). The majority of cases result from multiple insults: dehydration, drugs in conjunction with inflammation and/or sepsis. AKI may have a spectrum of being an incidental finding with no signs or symptoms to a moderate to severe condition with increased morbidity and mortality due to accumulation of nitrogenous waste products and fluid–electrolyte disorders. The aetiologies of AKI are numerous and can broadly be classified as pre-renal, intrinsic renal, and post-renal (obstructive). A thorough evaluation of the patients with AKI for diagnosis and treatment are required. There are no specific treatments, but eliminating aetiological reasons and protection from further kidney function loss are crucial. A balanced haemodynamic management along with a balanced fluid–electrolyte replacement and arranging drug dosages are important. Various modes of renal replacement therapies may be used for treating severe cases.

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