A Meta-Analysis of Extracorporeal Anticoagulants in Pediatric Continuous Kidney Replacement Therapy

2021 ◽  
pp. 088506662199275
Author(s):  
Rupesh Raina ◽  
Nirav Agrawal ◽  
Kirsten Kusumi ◽  
Avisha Pandey ◽  
Abhishek Tibrewal ◽  
...  
Keyword(s):  
Replacement Therapy ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Electrolyte Imbalance ◽  
Therapeutic Modality ◽  
Regional Citrate Anticoagulation ◽  
Increased Risk ◽  
Study Results ◽  
Significant Difference ◽  
Kidney Replacement Therapy

Objective: Continuous kidney replacement therapy (CKRT) is the primary therapeutic modality utilized in hemodynamically unstable patients with severe acute kidney injury. As the circuit is extracorporeal, it poses an increased risk of blood clotting and circuit loss; frequent circuit losses affect the provider’s ability to provide optimal treatment. The objective of this meta-analysis is to evaluate the safety and efficacy of the extracorporeal anticoagulants in the pediatric CKRT population. Data Sources: We conducted a literature search on PubMed/Medline and Embase for relevant citations. Study Selection: Studies were included if they involved patients under the age of 18 years undergoing CKRT, with the use of anticoagulation (heparin, citrate, or prostacyclin) as a part of therapy. Only English articles were included in the study. Data Extraction: Initial search yielded 58 articles and a total of 24 articles were included and reviewed. A meta-analysis was performed focusing on the safety and effectiveness of regional citrate anticoagulation (RCA) vs unfractionated heparin (UFH) anticoagulants in children. Data Synthesis: RCA had statistically significantly longer circuit life of 50.65 hours vs. UFH of 42.10 hours. Two major adverse effects metabolic alkalosis and electrolyte imbalance seen more commonly in RCA compared to UFH. There was not a significant difference in the risk of systemic bleeding when comparing RCA vs. UFH. Conclusion: RCA is the preferred anticoagulant over UFH due to its significantly longer circuit life, although vigilant circuit monitoring is required due to the increased risk of electrolyte disturbances. Prostacyclin was not included in the meta-analysis due to the lack of data in pediatric patients. Additional studies are needed to strengthen the study results further.

scholarly journals Acute kidney injury and kidney replacement therapy in COVID-19: a systematic review and meta-analysis

2020 ◽  
Vol 13 (4) ◽  
pp. 550-563 ◽  
Author(s):  
Edouard L Fu ◽  
Roemer J Janse ◽  
Ype de Jong ◽  
Vera H W van der Endt ◽  
Jet Milders ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Acute Kidney Injury ◽  
Replacement Therapy ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Original Data ◽  
Increased Risk ◽  
Kidney Replacement Therapy ◽  
Meta Regression

Abstract Background Acute kidney injury (AKI) can affect hospitalized patients with coronavirus disease 2019 (COVID-19), with estimates ranging between 0.5% and 40%. We performed a systematic review and meta-analysis of studies reporting incidence, mortality and risk factors for AKI in hospitalized COVID-19 patients. Methods We systematically searched 11 electronic databases until 29 May 2020 for studies in English reporting original data on AKI and kidney replacement therapy (KRT) in hospitalized COVID-19 patients. Incidences of AKI and KRT and risk ratios for mortality associated with AKI were pooled using generalized linear mixed and random-effects models. Potential risk factors for AKI were assessed using meta-regression. Incidences were stratified by geographic location and disease severity. Results A total of 3042 articles were identified, of which 142 studies were included, with 49 048 hospitalized COVID-19 patients including 5152 AKI events. The risk of bias of included studies was generally low. The pooled incidence of AKI was 28.6% [95% confidence interval (CI) 19.8–39.5] among hospitalized COVID-19 patients from the USA and Europe (20 studies) and 5.5% (95% CI 4.1–7.4) among patients from China (62 studies), whereas the pooled incidence of KRT was 7.7% (95% CI 5.1–11.4; 18 studies) and 2.2% (95% CI 1.5–3.3; 52 studies), respectively. Among patients admitted to the intensive care unit, the incidence of KRT was 20.6% (95% CI 15.7–26.7; 38 studies). Meta-regression analyses showed that age, male sex, cardiovascular disease, diabetes mellitus, hypertension and chronic kidney disease were associated with the occurrence of AKI; in itself, AKI was associated with an increased risk of mortality, with a pooled risk ratio of 4.6 (95% CI 3.3–6.5). Conclusions AKI and KRT are common events in hospitalized COVID-19 patients, with estimates varying across geographic locations. Additional studies are needed to better understand the underlying mechanisms and optimal treatment of AKI in these patients.

scholarly journals Continuous renal replacement therapy in COVID-19—associated AKI: adding heparin to citrate to extend filter life—a retrospective cohort study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Eduardo de Oliveira Valle ◽  
Carla Paulina Sandoval Cabrera ◽  
Claudia Coimbra César de Albuquerque ◽  
Giovanio Vieira da Silva ◽  
Márcia Fernanda Arantes de Oliveira ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Unfractionated Heparin ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Regional Citrate Anticoagulation ◽  
Bleeding Events ◽  
Increased Risk ◽  
The Impact ◽  
D Dimer

Abstract Background Coronavirus disease 2019 (COVID-19) may predispose patients to thrombotic events. The best anticoagulation strategy for continuous renal replacement therapy (CRRT) in such patients is still under debate. The purpose of this study was to evaluate the impact that different anticoagulation protocols have on filter clotting risk. Methods This was a retrospective observational study comparing two different anticoagulation strategies (citrate only and citrate plus intravenous infusion of unfractionated heparin) in patients with acute kidney injury (AKI), associated or not with COVID-19 (COV + AKI and COV − AKI, respectively), who were submitted to CRRT. Filter clotting risks were compared among groups. Results Between January 2019 and July 2020, 238 patients were evaluated: 188 in the COV + AKI group and 50 in the COV − AKI group. Filter clotting during the first filter use occurred in 111 patients (46.6%). Heparin use conferred protection against filter clotting (HR = 0.37, 95% CI 0.25–0.55), resulting in longer filter survival. Bleeding events and the need for blood transfusion were similar between the citrate only and citrate plus unfractionated heparin strategies. In-hospital mortality was higher among the COV + AKI patients than among the COV − AKI patients, although it was similar between the COV + AKI patients who received heparin and those who did not. Filter clotting was more common in patients with D-dimer levels above the median (5990 ng/ml). In the multivariate analysis, heparin was associated with a lower risk of filter clotting (HR = 0.28, 95% CI 0.18–0.43), whereas an elevated D-dimer level and high hemoglobin were found to be risk factors for circuit clotting. A diagnosis of COVID-19 was marginally associated with an increased risk of circuit clotting (HR = 2.15, 95% CI 0.99–4.68). Conclusions In COV + AKI patients, adding systemic heparin to standard regional citrate anticoagulation may prolong CRRT filter patency by reducing clotting risk with a low risk of complications.

scholarly journals Hydroxyethyl starch 130/0.4 for volume replacement therapy in surgical patients: a systematic review and meta-analysis of randomized controlled trials

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Yi Xu ◽  
Siying Wang ◽  
Leilei He ◽  
Hong Yu ◽  
Hai Yu
Keyword(s):  
Replacement Therapy ◽  
Meta Analysis ◽  
Postoperative Mortality ◽  
Kidney Injury ◽  
Volume Replacement ◽  
Surgical Patients ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Volume Replacement Therapy ◽  
Type Of Surgery

Abstract Background The safety of perioperative intravenous hydroxyethyl starch (HES) products, specifically HES 130/0.4, continues to be the source of much debate. The aim of this meta-analysis was to update the existing evidence and gain further insight into the clinical effects of HES 130/0.4 on postoperative outcomes for volume replacement therapy in surgical patients. Methods MEDLINE, EMBASE, and Cochrane Library databases were searched from inception to March 2020 for relevant randomized controlled trials (RCTs) on perioperative use of HES 130/0.4 in adult surgical patients. The primary outcome was postoperative mortality and secondary outcomes were the incidence of acute kidney injury (AKI) and requirement for renal replacement therapy (RRT). The analysis was performed using the random-effects method and the risk ratio (RR) with a 95% confidence interval (CI). We performed the risk-of-bias assessment of eligible studies and assessed the overall quality of evidence for each outcome. Results Twenty-five RCTs with 4111 participants were finally included. There were no statistical differences between HES 130/0.4 and other fluids in mortality at 30 days (RR 1.28, 95% CI 0.88 to 1.86, p = 0.20), the incidence of AKI (RR 1.23, 95% CI 0.99 to 1.53, p = 0.07), or requirement for RRT (RR 0.75, 95% CI 0.37 to 1.53, p = 0.43). Overall, there was a moderate certainty of evidence for all the outcomes. There was no subgroup difference related to the type of surgery (p = 0.17) in the incidence of AKI. As for the type of comparator fluids, however, there was a trend that was not statistically significant (p = 0.06) towards the increased incidence of AKI in the HES 130/0.4 group (RR 1.22, 95% CI 0.97 to 1.54) compared with the crystalloid group (RR 1.21, 95% CI 0.27 to 3.91). Subgroup analyses according to the type of surgery demonstrated consistent findings. Conclusions This systematic review and meta-analysis suggests that the use of HES 130/0.4 for volume replacement therapy compared with other fluids resulted in no significant difference in postoperative mortality or kidney dysfunction among surgical patients. Given the absent evidence of confirmed benefit and the potential trend of increased kidney injury, we cannot recommend the routine clinical use of HES 130/0.4 for volume replacement therapy in surgical patients from the perspective of benefit/risk profile. However, the results need to be interpreted with caution due to the limited sample size, and further well-powered RCTs are warranted. Trial registration PROSPERO registry reference: CRD42020173058

914 A Comparison of Mortality, Indicators of Treatment Success and Complications of Resuscitative Endovascular Balloon Occlusion of Aorta (REBOA): A Systematic Review and Meta-Analysis

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
H J Ko ◽  
H F Koo ◽  
S Froghi ◽  
N Al-Saadi
Keyword(s):  
Hospital Mortality ◽  
Meta Analysis ◽  
Treatment Success ◽  
Estimation Method ◽  
Kidney Injury ◽  
Balloon Occlusion ◽  
Random Effects Model ◽  
Resuscitative Thoracotomy ◽  
Significant Difference ◽  
Endovascular Balloon Occlusion

Abstract Introduction This study aims to provide an updated review on in-hospital mortality rates in patients who underwent Resuscitative Endovascular Balloon Occlusion of Aorta (REBOA) versus Resuscitative thoracotomy (RT) or standard care without REBOA, to identify potential indicators of REBOA use and complications. Method Cochrane and PRISMA guidelines were used to perform the study. A literature search was done from 01 January 2005 to 30 June 2020 using EMBASE, MEDLINE and COCHRANE databases. Meta-analysis was conducted using a random effects model and the DerSimonian and Laird estimation method. Results 25 studies were included in this study. The odds of in-hospital mortality of patients who underwent REBOA compared to RT was 0.18 (p < 0.01). The odds of in-hospital survival of patients who underwent REBOA compared to non-REBOA was 1.28 (p = 0.62). There was a significant difference found between survivors and non-survivors in terms of their pre-REBOA systolic blood pressure (SBP) (19.26 mmHg, p < 0.01), post-REBOA SBP (20.73 mmHg, p < 0.01), duration of aortic occlusion (-40.57 mins, p < 0.01) and ISS (-8.50, p < 0.01). Common complications of REBOA included acute kidney injury, multi-organ dysfunction and thrombosis. Conclusions Our study demonstrated lower in-hospital mortality of REBOA versus RT. Prospective multi-centre studies are needed for further evaluation of the indications, feasibility, and complications of REBOA.

scholarly journals Optimal dose of renal replacement therapy in acute kidney injury: a meta-analysis

Critical Care ◽  
2009 ◽  
Vol 13 (Suppl 1) ◽  
pp. P268
Author(s):  
RJ Van Wert ◽  
DC Scales ◽  
JO Friedrich ◽  
R Wald ◽  
NK Adhikari
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Optimal Dose
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