scholarly journals Metformin-Associated Lactic Acidosis Undergoing Renal Replacement Therapy in Intensive Care Units: A Five-Million Population-Based Study in the North-West of Italy

2017 ◽  
Vol 44 (3) ◽  
pp. 198-205 ◽  
Author(s):  
Filippo Mariano ◽  
Marco Pozzato ◽  
Paola Inguaggiato ◽  
Cesare Guarena ◽  
Ernesto Turello ◽  
...  
Keyword(s):  
Intensive Care ◽  
Survival Rate ◽  
Renal Replacement Therapy ◽  
Lactic Acidosis ◽  
Replacement Therapy ◽  
Intensive Care Units ◽  
High Efficiency ◽  
Journal Club ◽  
Large Population ◽  
High Survival

Background: Metformin-associated lactic acidosis (MALA) is a severe complication of drug administration with significant morbidity and mortality. So far no study in large population areas have examined the incidence, clinical profile and outcome of acute kidney injury (AKI)-MALA patients admitted in intensive care units (ICUs) and treated by renal replacement therapy (MALA-RRT). Methods: Retrospective analysis over a 6-year period (2010-2015) in Piedmont and Aosta Valley regions (5,305,940 inhabitants, 141,174 diabetics treated with metformin) of all MALA-RRT cases. Results: One hundred and seventeen cases of AKI-MALA-RRT were observed (12.04/100,000 metformin treated diabetics, 1.45% of all RRT-ICU patients). Survival rate was 78.3%. The average duration of RRT was 4.0 days at mean dialysis effluent of 977 mL/kg/day. At admission most patients were dehydrated, and experienced shock and oliguria. Conclusion: Our data showed that MALA-RRT is a common complication, needing more prevention. Adopted policy of early, extended, continuous and high efficiency dialysis could contribute to an observed high survival rate. Video Journal Club “Cappuccino with Claudio Ronco” at http://www.karger.com/?doi=471917.

scholarly journals Acute Renal Replacement Therapy in Intensive Care Units versus Outside Intensive Care Units: Are They Different?

2020 ◽  
Vol Volume 13 ◽  
pp. 203-209
Author(s):  
Daniela Ponce ◽  
Welder Zamoner ◽  
Vanessa Addad ◽  
Marci Maria Batistoco ◽  
André Balbi
Keyword(s):  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Intensive Care Units

scholarly journals MO861THE PROGNOSIS OF PATIENTS RECEIVING CONTINUOUS RENAL REPLACEMENT THERAPY (CRRT) AFTER CARDIOVASCULAR SURGERY DEPENDS ON THE INDICATION FOR ITS INITIATION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Nikolaos Schizas ◽  
Maria Smyrli ◽  
Aikaterini Dedeilia ◽  
Vasilios Patris ◽  
Ilias Samiotis ◽  
...  
Keyword(s):  
Survival Rate ◽  
Renal Replacement Therapy ◽  
Mortality Rate ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Cardiovascular Surgery ◽  
High Survival ◽  
Key Factor ◽  
Life Threatening ◽  
First Time

Abstract Background and Aims Continuous Renal Replacement Therapy is required in 2.6% to 5% of patients who have undergone cardiovascular surgery. Although its implementation is frequent, several aspects of this therapeutic measure still remain uncertain. Method The data of all patients who were surgically treated during a 3-year period (2017-2019) at a single cardiovascular department were collected and the cases in which continuous renal replacement therapy was used were identified. From this group, the data of those that received dialysis for the first time were analyzed. Results In about 5% of patients renal replacement was inevitable, and the mortality rate among them reached 57.6%. The mean duration of renal therapy was 8.4 days. The investigation of laboratory parameters in different stages revealed certain aspects about the expected outcomes. The survival rate varied significantly in relation to the indication for CRRT. Fluid overload and electrolytic disorders were associated with high survival rate, while oliguria or anuria, acidosis or intoxications were linked to increased mortality rate. Conclusion Despite CRRT being associated with high mortality rates, it is the only option for life-threatening conditions in clinical practice. The indication for CRRT is a key factor for the prognosis, decision-making and the overall management of a patient.

Patients with Severe Lactic Acidosis in the Intensive Care Unit: A Retrospective Study of Contributing Factors and Impact of Renal Replacement Therapy

2021 ◽  
pp. 1-7
Author(s):  
Lyssa Van De Ginste ◽  
Floris Vanommeslaeghe ◽  
Eric A.J. Hoste ◽  
Jan M. Kruse ◽  
Wim Van Biesen ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Lactic Acidosis ◽  
Replacement Therapy ◽  
Lactate Level ◽  
Cohort Analysis ◽  
Adverse Outcomes ◽  
Contributing Factors ◽  
Severe Lactic Acidosis

<b><i>Introduction:</i></b> Hyperlactatemia is a regular condition in the intensive care unit, which is often associated with adverse outcomes. Control of the triggering condition is the most effective treatment of hyperlactatemia, but since this is mostly not readily possible, extracorporeal renal replacement therapy (RRT) is often tried as a last resort. The present study aims to evaluate the factors that may contribute to the decision whether to start RRT or not and the potential impact of the start of RRT on the outcome in patients with severe lactic acidosis (SLA) (lactate ≥5 mmol/L). <b><i>Materials and Methods:</i></b> We conducted a retrospective single-center cohort analysis over a 3-year period including all patients with a lactate level ≥5 mmol/L. Patients were considered as treated with RRT because of SLA if RRT was started within 24 h after reaching a lactate level ≥5 mmol/L. <b><i>Results:</i></b> Overall, 90-day mortality in patients with SLA was 34.5%. Of the 1,203 patients who matched inclusion/exclusion criteria, 11% (<i>n</i> = 133) were dialyzed within 24 h. The propensity to receive RRT was related to the lactate level and to the SOFA renal and cardio score. The most frequently used modality was continuous RRT. Patients who were started on RRT versus those who did not have 2.3 higher odds of mortality, even after adjustment for the propensity to start RRT. <b><i>Conclusions:</i></b> Our analysis confirms the high mortality rate of patients with SLA. It adds that odds for mortality is even higher in patients who were started on RRT versus not. We suggest keeping an open mind to the factors that may influence the decision to start dialysis and bear in mind that without being a bridge to correction of the underlying condition, dialysis is unlikely to affect the outcome.

Continuous renal replacement therapy for critically ill patients in the intensive care units of two tertiary hospitals. v1

2021 ◽  
Author(s):  
Jorge not provided not provided Machado Alba
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Severity Scores

Introduction: Acute kidney injury is characterized by a sudden decrease in renal function. The objective was to determine the variables that are associated with the need for continuous renal replacement therapy and its outcome in critically ill patients treated in two intensive care units. Methods. A cohort follow-up study with reviewed clinical histories of 140 patients admitted between January-2012 and July-2015, who were receiving continuous therapy, and the main outcome was survival after discharge. Clinical variables, severity scores, disease prognosis, continuous renal replacement techniques and outcomes were collected. Results. Mean age was 61.9±17.6 years, and 60.7% were men. Septic shock was the main cause of acute kidney injury. In total, 79.4% of cases died in the intensive care units. The median dose of continuous renal replacement therapy was 28 ml/kg/hour (interquartile range: 35-37). The late initiation of the therapy between 25-72 hours after the diagnosis increased the probability that the patient would experience a fatal outcome (OR:6.9, 95%CI:1.5-33.0). Conclusions: Acute kidney injury secondary to sepsis is a frequent condition in critically ill patients and is associated with high mortality rates. In these cases, continuous renal replacement therapy was the main recourse for its treatment.

Early Mobility Activities During Continuous Renal Replacement Therapy

2014 ◽  
Vol 23 (4) ◽  
pp. 348-351 ◽  
Author(s):  
Cherylynn A. Brownback ◽  
Patricia Fletcher ◽  
Lynelle N. B. Pierce ◽  
Susan Klaus
Keyword(s):  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Intensive Care Units ◽  
Bed Rest ◽  
Therapeutic Technique ◽  
Early Mobility ◽  
Hemodynamic State

Continuous renal replacement therapy (CRRT) is a therapeutic technique used to support critically ill patients with acute renal failure in intensive care units. CRRT is preferred over hemodialysis for patients who cannot tolerate the rapid fluid and electrolyte shifts associated with hemodialysis because of their tenuous hemodynamic state. Traditionally, such patients have not been candidates for mobilization and have remained on strict bed rest. Mobilization is now being initiated on patients undergoing CRRT in intensive care units. This case study chronicles the successful mobilization of a patient undergoing CRRT. This experience suggests that CRRT patients who are appropriate candidates may be mobilized safely and therefore should not automatically be excluded from mobilization therapies.

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