Platelet Decreases following Continuous Renal Replacement Therapy Initiation as a Novel Risk Factor for Renal Nonrecovery

2021 ◽  
pp. 1-8
Author(s):  
Benjamin R. Griffin ◽  
Patrick Ten Eyck ◽  
Sarah Faubel ◽  
Diana Jalal ◽  
Martin Gallagher ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Clinical Effect ◽  
Secondary Analysis ◽  
Renal Recovery ◽  
Cut Points ◽  
Randomized Evaluation ◽  
Therapy Initiation ◽  
Renal Replacement Therapy Initiation

<b><i>Background:</i></b> Continuous renal replacement therapy (CRRT) is a form of dialysis used in critically ill patients, and has recently been associated with renal nonrecovery. Decreases in platelets following CRRT initiation are common and are associated with mortality, but associations with renal recovery are unclear. Our objective was to determine if platelet nadir or the degree of platelet decrease following CRRT initiation was associated with renal nonrecovery. <b><i>Methods:</i></b> This is a secondary analysis of the Randomized Evaluation of Normal versus Augmented Level (RENAL) trial. Primary predictors were platelet nadir discretized by median value and percent platelet decrease following CRRT initiation, with cut points evaluated by decile from 30 to 60%. The 2 primary outcomes were time to RRT-independence and RRT-free days. Secondary outcomes were 28-day mortality, 90-day mortality, intensive care unit (ICU)-free, and hospital-free days. <b><i>Results:</i></b> Time to RRT independence censored for death was achieved less frequently in patients with low platelet nadir (hazard ratio [HR] 0.77, confidence interval [CI] 0.66–0.91) and in those with &#x3e;50% platelet decrease (HR 0.84, CI 0.72–0.97). RRT-free days were lower in both low platelet nadir (odds ratio [OR] 0.94, CI 0.90–0.97) and &#x3e;50% platelet decrease (OR 0.91, CI 0.88–0.95). These groups also had higher rates of 28- and 90-day mortality and fewer ICU-free and hospital-free days. Thrombocytopenia at CRRT initiation was also associated with renal nonrecovery, although the clinical effect was small. <b><i>Conclusions:</i></b> Platelet nadir &#x3c;100 × 10<sup>3</sup>/µL and platelet decrease by &#x3e;50% following CRRT initiation were both associated with lower rates of renal recovery. Further research is needed to evaluate mechanisms-linking platelet changes and renal nonrecovery in CRRT.

scholarly journals IMPACT OF TIMING OF RENAL REPLACEMENT THERAPY INITIATION ON OUTCOME OF ACUTE KIDNEY INJURY IN SEPTIC PATIENTS

2021 ◽  
Vol 71 (Suppl-1) ◽  
pp. S213-18
Author(s):  
Muhammad Nasir ◽  
Madiha Hashmi ◽  
Muhammad Sohaib ◽  
Zahoor Ahmed ◽  
Muhammad Salman ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Blood Urea Nitrogen ◽  
Kidney Injury ◽  
Urea Nitrogen ◽  
Therapy Initiation ◽  
Renal Replacement Therapy Initiation ◽  
Late Group

Objective: To identify whether the timing of initiation of continuous renal replacement therapy affects outcome in septic patients with acute kidney injury in term of 28 days mortality. Study Design: Cross sectional analytical study. Place and Duration of Study: This research was conducted at department of Anaesthesiology and critical careunit of the Aga Khan University Hospital, Karachi, from Oct 2018 to Jun 2019. Methodology: The study reviewed all adult patients aged >18 years who developed acute kidney injury afterseptic shock and required continuous renal replacement therapy in surgical intensive care unit. Considering thevalue of blood urea nitrogen, patients were classified into two groups. One was in early group that‟s was defined as blood urea nitrogen value of <100 mg/dl just before continuous renal replacement therapy initiation while the patients who have blood urea nitrogen value of ≥100 mg/dl just prior to continuous renal replacement therapy initiation were classified as late group. Kaplan-Meier survival analysis was performed and median survival was computed. Results: Forty patients were included for analysis. There were thirty patients (75%) in early group in whomcontinuous renal replacement therapy was started with mean blood urea nitrogen of 66 ± 20.2 mg/dL and 10(25%) patients were in late group with mean blood urea nitrogen of 137 ± 28.4 mg/dL. The overall survival ratesin both groups were 49.6%, and 10.4% at 10 and 25 days, respectively. Median survival time was not statisticallysignificant between early and late continuous renal replacement...........

Heterogeneity of Effect of Net Ultrafiltration Rate among Critically Ill Adults Receiving Continuous Renal Replacement Therapy

2020 ◽  
pp. 1-11
Author(s):  
Ary Serpa Neto ◽  
Thummaporn Naorungroj ◽  
Raghavan Murugan ◽  
John A. Kellum ◽  
Martin Gallagher ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Sofa Score ◽  
Missing Values ◽  
Secondary Analysis ◽  
Patient Characteristics ◽  
Randomized Evaluation ◽  
Baseline Weight ◽  
Critically Ill Adults

<b><i>Introduction:</i></b> In continuous renal replacement therapy (CRRT)-treated patients, a net ultrafiltration (NUF) rate &#x3e;1.75 mL/kg/h has been associated with increased mortality. However, there may be heterogeneity of effect of NUF rate on mortality, according to patient characteristics. <b><i>Methods:</i></b> To investigate the presence and impact of heterogeneity of effect, we performed a secondary analysis of the “Randomized Evaluation of Normal versus Augmented Level of Renal Replacement Therapy” (RENAL) trial. Exposure was NUF rate (weight-adjusted fluid volume removed per hour) stratified into tertiles (&#x3c;1.01 mL/kg/h; 1.01–1.75 mL/kg/h; or &#x3e;1.75 mL/kg/h). Primary outcome was 90-day mortality. Patients were clustered according to baseline characteristics. Heterogeneity of effect was assessed according to clusters and baseline edema and related to the additional impact of baseline cardiovascular Sequential Organ Failure Assessment (SOFA) score. We excluded patients with missing values for baseline weight and/or treatment duration. <b><i>Results:</i></b> We identified 2 clusters. The largest (cluster 1; <i>n</i> = 941) included more severely ill patients, with more sepsis, more edema, and more vasopressor therapy (all <i>p</i> &#x3c; 0.001). Compared to the middle tertile, the probability of harm was greater with the high tertile of NUF rate in patients in cluster 1 and in patients with baseline edema (probability of harm, cluster 1: 99.9%; edema: 99.1%). Moreover, higher baseline cardiovascular SOFA score also increased mortality risk with both high and low compared to middle NUF rates in cluster 1 patients and in patients with edema. <b><i>Conclusions:</i></b> In CRRT patients, both high and low NUF rates may be harmful, especially in those with edema, sepsis, and greater illness severity. Cardiovascular SOFA scores modulate this association. Additional studies are needed to test these hypotheses, and targeted trials of NUF rates based on risk stratification appear justified. <b><i>Trial Registration:</i></b> ClinicalTrials.gov identifier: NCT00221013.

Evaluating the Risk of Developing Thrombocytopenia Within Five Days of Continuous Renal Replacement Therapy Initiation in Septic Patients

2020 ◽  
pp. 089719002095917
Author(s):  
Lauren Fay ◽  
Georgeanna Rechner-Neven ◽  
Drayton A. Hammond ◽  
Joshua M. DeMott ◽  
Mary Jane Sullivan
Keyword(s):  
Differential Diagnosis ◽  
Platelet Count ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Primary Outcome ◽  
Control Group ◽  
Chi Square ◽  
Time Zero ◽  
Renal Replacement Therapy Initiation

Background: The differential diagnosis for thrombocytopenia in critical illness is often extensive. This study was performed to determine the incidence of thrombocytopenia in septic patients undergoing continuous renal replacement therapy (CRRT) versus those not undergoing CRRT. Objective: The primary outcome of this study was to compare the development of thrombocytopenia, defined as a platelet count ≤ 100 × 103/mm3, in septic patients within 5 days of time zero. Time zero was defined as the baseline platelet count upon hospital admission or CRRT initiation. Methods: An IRB approved, retrospective cohort study was conducted evaluating thrombocytopenia development in critically ill, septic patients who were initiated on CRRT versus those whom were not. Baseline and clinical characteristics were displayed using descriptive statistics. The primary outcome was evaluated overall and in subgroups of CRRT using Chi-square tests. Results: One hundred sixty patients, 80 per arm, were included in the study. Thrombocytopenia development within 5 days occurred more frequently in the renal replacement therapy (RRT) group compared to the control group (67.5% vs. 6.3%, p < 0.001). In the subgroup analysis of the RRT cohort, thrombocytopenia development within 5 days occurred more frequently in the continuous veno-venous hemofiltration (CVVH) group compared to the accelerated veno-venous hemofiltration (AVVH) group (76% vs. 53.3%, p = 0.049). Conclusion: There is a high likelihood that septic patients initiated on CRRT will develop thrombocytopenia during their hospital stay. Patients receiving CVVH may develop thrombocytopenia more frequently than those receiving AVVH. Overall, CRRT should remain a differential diagnosis for thrombocytopenia development in this patient population.

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