Patients receiving renal replacement therapy with hemodialysis and taking NSAIDS: real clinical practice

Nephrology ◽  
2021 ◽  
Vol 4_2021 ◽  
pp. 43-47
Author(s):  
A.P. Rebrov Rebrov ◽  
E.V. Grigoryeva Grigoryeva ◽  
G.S. Petrov Petrov ◽  
J.I. Vorobieva Vorobieva ◽  
M.S. Sitnikova Sitnikova ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Real Clinical Practice

Impact of different hemodiafiltration solutions on ionemia in long-term CRRT

2021 ◽  
pp. 039139882110432
Author(s):  
Federico Nalesso ◽  
Francesco Garzotto ◽  
Leda Cattarin ◽  
Georgie Innico ◽  
Laura Gobbi ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Balance Control ◽  
Kidney Injury ◽  
Critical Issue ◽  
University Hospital ◽  
Electrolyte Balance ◽  
Standard Clinical Practice ◽  
The Impact

Critical patients with Acute Kidney Injury (AKI) requiring renal replacement therapy are in most cases eligible only for continuous modalities where the electrolyte balance control is a critical issue. The standard solutions used for hemodiafiltration, containing potassium at 2 mmol/L and no phosphorus, determines during the extended renal replacement therapy hypokalemia and hypophosphatemia. Therefore, solutions containing potassium and phosphate in physiological concentrations were formulated to avoid electrolyte imbalances and reduce ion alterations in prolonged treatments, these solutions are not routinely used in the standard clinical practice. To avoid electrolyte imbalances, we have first introduced in our practice two different solutions and then we have retrospectively analyzed the electrolyte balance upon these two solutions in order to identity the impact of these solutions on potassium and phosphate according to our clinical practice. We retrospectively analyzed 96 patients treated with Continuous Renal Replacement Therapy (CRRT) in the intensive care units (ICU) at Padua’s University Hospital to evaluate the role on electrolyte balance of Phoxilium® and Prismasol 2® that differ in their composition and the need for electrolytes infusions. In the Phoxilium group the frequency of hypokalemia, hypophosphatemia, and the need of potassium and phosphate replacement were significantly reduced resulting in a reduction in complications, workload, and clinical risk associated with infusions of electrolytes. Our data demonstrated that the use of these two different hemodiafiltration solutions can reduce the occurrence of hypokalemia and hypophosphatemia during CRRT performing personalized treatments without the use of potassium and phosphate infusions.

scholarly journals Patient Selection and Timing of Continuous Renal Replacement Therapy

2016 ◽  
Vol 42 (3) ◽  
pp. 224-237 ◽  
Author(s):  
Marlies Ostermann ◽  
Michael Joannidis ◽  
Antonello Pani ◽  
Matteo Floris ◽  
Silvia De Rosa ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Patient Selection ◽  
Kidney Injury ◽  
Practice Variation ◽  
Standards Of Care ◽  
Future Research ◽  
Controversial Topic

When and in whom to initiate continuous renal replacement therapy (CRRT) for acute kidney injury (AKI) remains a highly controversial topic with large practice variation around the world. Even within countries, practice variation exists and recommendations for clinical practice are not specific. In this article, we report the consensus recommendations for timing and patient selection for CRRT - the results of the 2016 Acute Disease Quality Initiative XVII conference on ‘precision CRRT'. We suggest that these recommendations could serve to develop the best clinical practice and standards of care for use of CRRT in patients with AKI. Finally, we identify and highlight the areas of ongoing uncertainty and propose an agenda for future research.

Continuous veno-venous hemofiltration with regional citrate anticoagulation: A four-year single-center experience

2008 ◽  
Vol 31 (11) ◽  
pp. 937-943 ◽  
Author(s):  
T. Cassina ◽  
R. Mauri ◽  
A. Engeler ◽  
O. Giannini
Keyword(s):  
Clinical Practice ◽  
Renal Replacement Therapy ◽  
Life Span ◽  
Replacement Therapy ◽  
Ionized Calcium ◽  
Buffer Effect ◽  
Acid Base ◽  
Replacement Solution ◽  
Citrate Accumulation ◽  
Regional Anticoagulation

Background Hemofiltration protocols using a citrate-buffered replacement solution offer the advantage of regional anticoagulation and a buffer effect. The role played by such fluids in clinical practice is not yet well established. The risk of electrolytic disorders, acid-base imbalance, or citrate accumulation should be clarified. We report on a renal therapy protocol based on a citrate isonatremic replacement solution. Method We considered all patients needing renal replacement therapy admitted to our cardiovascular intensive care unit between January 2003 and June 2007. A citrate-buffered fluid was delivered in pre-dilution mode to a post-filter ionized calcium target ≤0.25 mmol/L. Extracorporeal blood flow was set at a constant of 140±10 ml/min. Blood calcemia was maintained by a 5% calcium-chloride solution infused into the patient. We recorded the patients' acid-base variables, ionized calcium, daily electrolytes, albumin, urea and filter life-span. Results We observed 101 consecutive patients out of 2,523; incidence 4%, overall mortality was 57% at ICU discharge. Mean replacement rate was 2,554±475 ml/h corresponding to 34±5 ml/kg/h. Mean patient ionized calcium level was 1.07±0.04 mmo/L, maintained by 13±2 ml/h of infused calcium-chloride. All other electrolytes remained in the normal range. The Stewart biophysical approach confirmed a strong anion gap of 3.1± 3 meq/L. Acid-base balance showed a buffer effect. Mean filter life-span was 52±11 h. Conclusion Renal replacement therapy based on citrate-buffered fluid may be useful in clinical practice. This methodology presented an adequate metabolic control and allowed regional anticoagulation. A sufficient calcium supply was mandatory to avoid hypocalcemia. The small strong ion gap suggested a modest citrate accumulation.

scholarly journals Citrate: How to get started and what, when, and how to monitor?

2018 ◽  
Vol 6 (3) ◽  
pp. 115-127 ◽  
Author(s):  
Patrick M. Honore ◽  
David De Bels ◽  
Thierry Preseau ◽  
Sebastien Redant ◽  
Herbert D. Spapen
Keyword(s):  
Clinical Practice ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill Patients ◽  
Trisodium Citrate ◽  
Review Article ◽  
Regional Citrate Anticoagulation ◽  
High Concentration ◽  
Citrate Anticoagulation ◽  
Bactericidal Agent

Abstract In most of the case, regional citrate anticoagulation is using diluted citrate around 1% depending on the types used in clinical practice. Diluted citrate is much more safer when compared to highly concentrated citrate around 4% or even more. In clinical practice, trisodium citrate is used in high concentration (around 30%) as a bactericidal agent with anticoagulant properties for locking deep venous catheters used in hemodialysis (HD; close to 25–30% of citrate). In this review article, buffer and anticoagulant potential of citrate are discussed during renal replacement therapy in critically ill patients with particular focus on the practical approach at the bedside.

scholarly journals Use of glucagon-like peptide-1-receptor-agonists and risk of serious renal events: Scandinavian cohort study

2020 ◽  
Author(s):  
Björn Pasternak ◽  
Viktor Wintzell ◽  
Björn Eliasson ◽  
Ann-Marie Svensson ◽  
Stefan Franzén ◽  
...  
Keyword(s):  
Cohort Study ◽  
Clinical Practice ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Routine Clinical Practice ◽  
Absolute Difference ◽  
Active Comparator ◽  
Dipeptidyl Peptidase 4 ◽  
Receptor Agonists ◽  
Dpp4 Inhibitors

<i>Objective</i> <p>To assess the association between use of GLP1-receptor-agonists and risk of serious renal events in routine clinical practice.</p> <p><i>Research Design and Methods</i></p> <p>Cohort study using an active-comparator new-user design and nationwide register data from Sweden, Denmark and Norway, 2010-2016. The cohort included 38,731 new users of GLP1-receptor-agonists (liraglutide 92.5%; exenatide 6.2%; lixisenatide 0.7%; dulaglutide 0.6%), matched 1:1 on age, sex and propensity score to a new user of the active comparator, dipeptidyl-peptidase-4 (DPP-4) inhibitors. The main outcome was serious renal events, a composite including renal replacement therapy, death from renal causes and hospitalization for renal events. Secondary outcomes were the individual components of the main outcome. Hazard ratios (HRs) were estimated using Cox models and an intention-to-treat exposure definition. Mean (SD) follow-up time was 3.0 (1.7) years. </p> <p><i>Results</i></p> <p>Mean (SD) age of the study population was 59 (10) years and 18% had cardiovascular disease. A serious renal event occurred in 570 users of GLP1-receptor-agonists (incidence rate 4.8 events per 1000 person-years) and in 722 users of DPP4 inhibitors (6.3 events per 1000 person-years; hazard ratio [HR] 0.76, 95% CI 0.68-0.85; absolute difference -1.5 [-2.1 to -0.9] events per 1000 person-years). Use of GLP1-receptor-agonists was associated with a significantly lower risk of renal replacement therapy (HR 0.73 [0.62-0.87]) and hospitalization for renal events (HR 0.73 [0.65-0.83]) but not death from renal causes (HR 0.72 [0.48-1.10]). When using an as-treated exposure definition in which patients were censored at treatment cessation or switch to the other study drug, the HR for the primary outcome was 0.60 (0.49-0.74). </p> <p><i>Conclusion</i></p> In this large cohort of patients seen in routine clinical practice in three countries, use of GLP1-receptor-agonists, as compared with DPP4 inhibitors, was associated with a reduced risk of serious renal events.

scholarly journals Commentary on the NICE guideline on renal replacement therapy and conservative management

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Kunaal Kharbanda ◽  
Osasuyi Iyasere ◽  
Fergus Caskey ◽  
Matko Marlais ◽  
Sandip Mitra
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Practice ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Clinical Practice Guideline ◽  
Conservative Management ◽  
Practice Guideline ◽  
Disease Stage ◽  
Nice Guideline ◽  
Adults And Children

Abstract Background NICE Guideline NG107, “Renal replacement therapy and conservative management” (Renal replacement therapy and conservative management (NG107); 2018:1–33) was published in October 2018 and replaced the existing NICE guideline CG125, “Chronic Kidney Disease (Stage 5): peritoneal dialysis” (Chronic kidney disease (stage 5): peritoneal dialysis | Guidance | NICE; 2011) and NICE Technology Appraisal TA48, “Guidance on home compared with hospital haemodialysis for patients with end-stage renal failure”(Guidance on home compared with hospital haemodialysis for patients with end-stage renal failure (Technology appraisal guideline TA48); 2002) The aim of the NICE guideline (NG107) was to provide guidance on renal replacement therapy (RRT), including dialysis, transplant and conservative care, for adults and children with CKD Stages 4 and 5. The guideline is extremely welcomed by the Renal Association and it offers huge value to patients, clinicians, commissioners and key stakeholders. It overlaps and enhances current guidance published by the Renal Association including “Haemodialysis” (Clinical practice guideline: Haemodialysis; 2019) which was updated in 2019 after the publication of the NICE guideline, “Peritoneal Dialysis in Adults and Children” (Clinical practice guideline: peritoneal Dialysis in adults and children; 2017) and “Planning, Initiation & withdrawal of Renal Replacement Therapy” (Clinical practice guideline: planning, initiation and withdrawal of renal replacement therapy; 2014) (at present there are no plans to update this guideline). There are several strengths to NICE guideline NG107 and we agree with and support the vast majority of recommendation statements in the guideline. This summary from the Renal Association discusses some of the key highlights, controversies, gaps in knowledge and challenges in implementation. Where there is disagreement with a NICE guideline statement, we have highlighted this and a new suggested statement has been written.

scholarly journals Use of glucagon-like peptide-1-receptor-agonists and risk of serious renal events: Scandinavian cohort study

2020 ◽  
Author(s):  
Björn Pasternak ◽  
Viktor Wintzell ◽  
Björn Eliasson ◽  
Ann-Marie Svensson ◽  
Stefan Franzén ◽  
...  
Keyword(s):  
Cohort Study ◽  
Clinical Practice ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Routine Clinical Practice ◽  
Absolute Difference ◽  
Active Comparator ◽  
Dipeptidyl Peptidase 4 ◽  
Receptor Agonists ◽  
Dpp4 Inhibitors

<i>Objective</i> <p>To assess the association between use of GLP1-receptor-agonists and risk of serious renal events in routine clinical practice.</p> <p><i>Research Design and Methods</i></p> <p>Cohort study using an active-comparator new-user design and nationwide register data from Sweden, Denmark and Norway, 2010-2016. The cohort included 38,731 new users of GLP1-receptor-agonists (liraglutide 92.5%; exenatide 6.2%; lixisenatide 0.7%; dulaglutide 0.6%), matched 1:1 on age, sex and propensity score to a new user of the active comparator, dipeptidyl-peptidase-4 (DPP-4) inhibitors. The main outcome was serious renal events, a composite including renal replacement therapy, death from renal causes and hospitalization for renal events. Secondary outcomes were the individual components of the main outcome. Hazard ratios (HRs) were estimated using Cox models and an intention-to-treat exposure definition. Mean (SD) follow-up time was 3.0 (1.7) years. </p> <p><i>Results</i></p> <p>Mean (SD) age of the study population was 59 (10) years and 18% had cardiovascular disease. A serious renal event occurred in 570 users of GLP1-receptor-agonists (incidence rate 4.8 events per 1000 person-years) and in 722 users of DPP4 inhibitors (6.3 events per 1000 person-years; hazard ratio [HR] 0.76, 95% CI 0.68-0.85; absolute difference -1.5 [-2.1 to -0.9] events per 1000 person-years). Use of GLP1-receptor-agonists was associated with a significantly lower risk of renal replacement therapy (HR 0.73 [0.62-0.87]) and hospitalization for renal events (HR 0.73 [0.65-0.83]) but not death from renal causes (HR 0.72 [0.48-1.10]). When using an as-treated exposure definition in which patients were censored at treatment cessation or switch to the other study drug, the HR for the primary outcome was 0.60 (0.49-0.74). </p> <p><i>Conclusion</i></p> In this large cohort of patients seen in routine clinical practice in three countries, use of GLP1-receptor-agonists, as compared with DPP4 inhibitors, was associated with a reduced risk of serious renal events.

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