scholarly journals Effects of different techniques of peritoneal dialysis at the intra-abdominal pressure in a newborn

2021 ◽  
Vol 25 (2) ◽  
pp. 95-98
Author(s):  
M. G. Rekhviashvili ◽  
A. Yu. Razumovskiу ◽  
A. I. Makulova ◽  
S. A. Fomenko ◽  
G. P. Tukabaev ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Abdominal Cavity ◽  
Hemodynamic Instability ◽  
Extremely Low Birth Weight ◽  
Intraabdominal Pressure ◽  
Abdominal Pressure ◽  
Premature Newborns ◽  
Flow Modification

Introduction. Peritoneal dialysis (PD) is considered a very effective care for newborns with severe acute renal injury , and it is a method of choice for treating newborns in the end-stage renal failure who require chronic renal replacement therapy (RRT). The classical modification of peritoneal dialysis involves the introduction of dialysis solution into the abdominal cavity, its presence there for a certain time (exposure time) and its passive evacuation from the abdominal cavity. However, this technique of peritoneal dialysis causes an increased intra-abdominal pressure leading to a number of complications. PD in premature newborns, including those with extremely low body weight, has a number of features associated with extremely immature organs and tissues. One more problem is hemodynamic instability in this category of patients. Besides, peritoneal dialysis in the classical modification accompanied by increase in the intra-abdominal pressure can cause hemodynamic and respiratory disorders. The purpose of this article is to demonstrate the effect of the modified peritoneal dialysis, developed by the authors, at the intraabdominal pressure and compare it with the classical approach.Material and methods. A method of flow peritoneal dialysis in premature newborns has been developed, which significantly reduces the effect of peritoneal dialysis at the intra-abdominal pressure. Intra-abdominal pressure monitoring was performed using the invasive low pressure meter IInd 500/75 Triton. The values of intra-abdominal pressure in children receiving renal replacement therapy with various modifications of peritoneal dialysis were compared.Results. Our observations show that peritoneal dialysis in the flow modification avoids sharp fluctuations in intra-abdominal pressure. Conclusion. In our opinion, flow modification of peritoneal dialysis may be the method of choice for replacement therapy in deeply premature infants with low and extremely low birth weight.

scholarly journals A Brazilian Experience in Assisted Automated Peritoneal Dialysis: A Reliable and Effective Home Care Approach

2013 ◽  
Vol 33 (3) ◽  
pp. 252-258 ◽  
Author(s):  
Marcia Regina Gianotti Franco ◽  
Natália Fernandes ◽  
Claúdia Azevedo Ribeiro ◽  
Abdul Rashid Qureshi ◽  
Jose Carolino Divino–Filho ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Total Duration ◽  
Hemodynamic Instability ◽  
Technique Survival ◽  
Care Approach ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

IntroductionAutomated assisted peritoneal dialysis (AAPD) has been shown to be successful as renal replacement therapy for elderly and physically incapable end-stage renal disease (ESRD) patients. In early 2003, a pioneer AAPD program was initiated at GAMEN Renal Clinic in Rio de Janeiro, Brazil.ObjectiveWe evaluated the results of an AAPD program offered as an option to elderly ESRD patients with physical or cognitive debilities or as last resort to patients with vascular access failure or hemodynamic instability during hemodialysis.MethodsA cohort of 30 consecutive patients started AAPD from January 2003 to March 2008 and was followed to July 2009. Demographics, clinical and laboratory parameters, causes of death, and patient and technique survival were analyzed.ResultsMedian age of the patients was 72 years (range: 47 – 93 years), with 60% being older than 65. The Davies score was greater than 2 in 73% of patients, and the Karnofsky index was less than 70 in 40%. The overall peritonitis rate was 1 episode in 37 patient–months. The total duration of AAPD ranged from 3 to 72 months. Patient survival was 80% at 12 months, 60% at 24 months, and 23.3% at 48 months. The most common cause of death was cardiovascular problems (70%).ConclusionsIn this clinical observational study, AAPD fulfilled its expected role, offering an opportune, reliable, and effective homecare alternative for ESRD patients with no other renal replacement therapy options.

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

2011 ◽  
Vol 2011 ◽  
pp. 1-10 ◽  
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.

scholarly journals A CLINICAL CASE OF CONTINUOUS FLOW PERITONEAL DIALYSIS IN A ONE-MONTH OLD CHILD WITH ACUTE RENAL DAMAGE AND NECROTIZING ENTEROCOLITIS

2020 ◽  
Vol 24 (1) ◽  
pp. 45-49
Author(s):  
Mikhail G. Rekhviashvili ◽  
A. I. Makulova ◽  
A. B. Chashchukhina ◽  
O. Yu. Brunova ◽  
Yu. I. Kucherov ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Necrotizing Enterocolitis ◽  
Continuous Flow ◽  
Renal Damage ◽  
Clinical Case ◽  
Abdominal Cavity ◽  
Intestinal Wall ◽  
Premature Newborns ◽  
Flow Modification ◽  
Number Of Patients

Necrotizing enterocolitis of newborns (NEC) is a severe intestinal disease that occurs against the background of acute hypoxia, violations of normal colonization of the intestine by microflora, leading to necrosis and perforation of the intestinal wall, peritonitis. Frequency of occurrence of 1-5 cases per 1000 live-born children. Most often, premature babies and children with low birth weight get sick. The development of NEC in a child significantly worsens the prognosis and increases mortality. Modern development of medical technology has made it possible to provide assistance to extremely premature newborns, which has led to an increase in the number of patients with NEC who are in a critical condition due to the course of multi-organ failure, including kidney failure, which requires renal replacement therapy (RRT). The main method of RRT used in newborns and young children is peritoneal dialysis (PD). NEC in the initial stages is considered an absolute contraindication for performing invasive manipulations on the abdominal cavity, since the risk of disease progression with the development of complications requiring surgical intervention increases at times. Recently, peritoneal dialysis has also become widespread in deeply premature newborns, who are the main risk group for developing NEC. Peritoneal dialysis in the continuous flow modification eliminates high intra-abdominal tension, one of the provoking factors for the progression of NEC, and in foreign expert studies, there are reports that the dialysis solution improves the intestinal wall trophism. This article presents a clinical case of peritoneal dialysis in flow modification in a 1-month-old child with acute renal damage and necrotizing enterocolitis.

scholarly journals Intra-dialytic hypotension following the transition from continuous to intermittent renal replacement therapy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
William Beaubien-Souligny ◽  
Yifan Yang ◽  
Karen E. A. Burns ◽  
Jan O. Friedrich ◽  
Alejandro Meraz-Muñoz ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Hospital Mortality ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Hemodynamic Instability ◽  
Factors Associated ◽  
Definition Of ◽  
Vasopressor Use ◽  
Cumulative Fluid Balance ◽  
Intermittent Renal Replacement Therapy

Abstract Background Transition from continuous renal replacement therapy (CRRT) to intermittent renal replacement therapy (IRRT) can be associated with intra-dialytic hypotension (IDH) although data to inform the definition of IDH, its incidence and clinical implications, are lacking. We aimed to describe the incidence and factors associated with IDH during the first IRRT session following transition from CRRT and its association with hospital mortality. This was a retrospective single-center cohort study in patients with acute kidney injury for whom at least one CRRT-to-IRRT transition occurred while in intensive care. We assessed associations between multiple candidate definitions of IDH and hospital mortality. We then evaluated the factors associated with IDH. Results We evaluated 231 CRRT-to-IRRT transitions in 213 critically ill patients with AKI. Hospital mortality was 43.7% (n = 93). We defined IDH during the first IRRT session as 1) discontinuation of IRRT for hemodynamic instability; 2) any initiation or increase in vasopressor/inotropic agents or 3) a nadir systolic blood pressure of < 90 mmHg. IDH during the first IRRT session occurred in 50.2% of CRRT-to-IRRT transitions and was independently associated with hospital mortality (adjusted odds ratio [OR]: 2.71; CI 1.51–4.84, p < 0.001). Clinical variables at the time of CRRT discontinuation associated with IDH included vasopressor use, higher cumulative fluid balance, and lower urine output. Conclusions IDH events during CRRT-to-IRRT transition occurred in nearly half of patients and were independently associated with hospital mortality. We identified several characteristics that anticipate the development of IDH following the initiation of IRRT.

scholarly journals Continuous renal replacement therapy rescued life-threatening capillary leak syndrome in an extremely-low-birth-weight premature: a case report

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Li-Fen Yang ◽  
Jia-Chang Ding ◽  
Ling-Ping Zhu ◽  
Li-Xia Li ◽  
Meng-Qi Duan ◽  
...  
Keyword(s):  
Birth Weight ◽  
Renal Replacement Therapy ◽  
Low Birth Weight ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Therapeutic Option ◽  
Capillary Leak Syndrome ◽  
Extremely Low Birth Weight ◽  
Capillary Leak ◽  
Life Threatening

Abstract Background Capillary leak syndrome (CLS) is a rare disease characterized by profound vascular leakage and presents as a classic triad of hypotension, hypoalbuminemia and hemoconcentration. Severe CLS is mostly induced by sepsis and generally life-threatening in newborns, especially in premature infants. Continuous renal replacement therapy (CRRT) plays an important role of supportive treatment for severe CLS. Unfortunately, CRRT in preterm infants has rarely been well defined. Case presentation We report the case of a 11-day-old girl with CLS caused by sepsis, who was delivered by spontaneous vaginal delivery (SVD) at gestational age of 25 weeks and 4 days, and a birth weight of 0.89 Kilograms(kg). The infant received powerful management consisting of united antibiotics, mechanical ventilation, intravenous albumin and hydroxyethyl starch infusion, vasoactive agents, small doses of glucocorticoids and other supportive treatments. However, the condition rapidly worsened with systemic edema, hypotension, pulmonary exudation, hypoxemia and anuria in about 40 h. Finally, we made great efforts to perform CRRT for her. Fortunately, the condition improved after 82 h’ CRRT, and the newborn was rescued and gradually recovered. Conclusion CRRT is an effective rescue therapeutic option for severe CLS and can be successfully applied even in extremely-low-birth-weight premature.

scholarly journals Neutrophil Gelatinase-Associated Lipocalin as a Marker for Renal Dysfunction Detection in Critically Ill Patients with Increased Intraabdominal Pressure

2017 ◽  
Vol 3 (1) ◽  
pp. 24-28
Author(s):  
Claudiu Puiac ◽  
Janos Szederjesi ◽  
Alexandra Lazăr ◽  
Codruța Bad ◽  
Lucian Pușcașiu
Keyword(s):  
Renal Function ◽  
Intensive Care ◽  
Creatinine Clearance ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Abdominal Cavity ◽  
Intraabdominal Pressure ◽  
Abdominal Pressure ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Neutrophil Gelatinase

Abstract Introduction: Elevated intraabdominal pressure (IAP) it is known to have an impact on renal function trough the pressure transmitted from the abdominal cavity to the vasculature responsible for the renal blood flow. Intraabdominal pressure is found to be frequent in intensive care patients and also to be a predictor of mortality. Intra-abdominal high pressure is an entity that can have serious impact on intensive care admitted patients, studies concluding that if this condition progresses to abdominal compartment syndrome mortality is as high as 80%. Aim: The aim of this study was to observe if a link between increased intraabdominal pressure and modification in renal function exists (NGAL, creatinine clearance). Material and Method: The study enrolled 30 critically ill patients admitted in the Intensive Care Unit of SCJU Tîrgu Mures between November 2015 and August 2016. The study enrolled adult, hemodynamically stable patients admitted in intensive critical care - defined by a normal blood pressure maintained without any vasopressor or inotropic support, invasive monitoring using PICCO device and abdominal pressure monitoring. Results: The patients were divided into two groups based on the intraabdominal pressure values: normal intraabdominal pressure group= 52 values and increased intraabdominal group= 35 values. We compared the groups in the light of NGAL values, 24 hours diuresis, GFR and creatinine clearance. The groups are significantly different when compared in the light of NGAL values and GFR values. We obtained a statistically significant correlation between NGAL value and 24 hour diuresis. No other significant correlations were encountered between the studied items. Conclusions: NGAL values are increased in patients with high intraabdominal pressure which may suggest its utility as a cut off marker for patients with increased intraabdominal pressure. There is a significant decreased GFR in patient with elevated intraabdominal pressure, observation which can help in early detection of renal injury in patients due to high intraabdominal pressure. No correlation was found between creatinine clearance and increased intraabdominal pressure.

Continuous Hemodiafiltration in Children

PEDIATRICS ◽  
1990 ◽  
Vol 85 (5) ◽  
pp. 819-823
Author(s):  
Nancy A. Bishof ◽  
Thomas R. Welch ◽  
C. Frederic Strife ◽  
Frederick C. Ryckman
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Peritoneal Dialysis ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Effective Means ◽  
Tumor Lysis Syndrome ◽  
Intermittent Hemodialysis ◽  
Tumor Lysis ◽  
Continuous Arteriovenous Hemofiltration

Continuous arteriovenous hemofiltration is a form of renal replacement therapy whereby small molecular weight solutes and water are removed from the blood via convection, alleviating fluid overload and, to a degree, azotemia. It has been used in many adults and several children. However, in patients with multisystem organ dysfunction and acute renal failure, continuous arteriovenous hemofiltration alone may not be sufficient for control of azotemia; intermittent hemodialysis or peritoneal dialysis may be undesirable in such unstable patients. Recently, the technique of continuous arteriovenous hemodiafiltration has been used in many severely ill adults. We have used continuous arteriovenous hemodiafiltration in four patients at Children's Hospital Medical Center. Patient 1 suffered perinatal asphyxia and oliguria while on extracorporeal membrane oxygenation. Patients 2 and 4 both had Burkitt lymphoma and tumor lysis syndrome. Patient 3 had septic shock several months after a bone marrow transplant. All had acute renal failure and contraindications to hemodialysis or peritoneal dialysis. A blood pump was used in three of the four patients, while spontaneous arterial flow was adequate in one. Continuous arteriovenous hemodiafiltration was performed for varying lengths of time, from 11 hours to 7 days. No patient had worsening of cardiovascular status or required increased pressor support during continuous arteriovenous hemodiafiltration. The two survivors (patients 2 and 4) eventually recovered normal renal function. Continuous arteriovenous hemodiafiltration is a safe and effective means of renal replacement therapy in the critically ill child. It may be ideal for control of the metabolic and electrolyte abnormalities of the tumor lysis syndrome.

Peritoneal dialysis: The unique features by compartmental delivery of renal replacement therapy

2017 ◽  
Vol 108 ◽  
pp. 128-132 ◽  
Author(s):  
Tibor Fülöp ◽  
Lajos Zsom ◽  
Mihály B. Tapolyai ◽  
Miklos Z. Molnar ◽  
Sohail Abdul Salim ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Replacement Therapy ◽  
Replacement Therapy

scholarly journals Erythrocyte Sedimentation Rate in Patients with Renal Insufficiency and Renal Replacement Therapy

2021 ◽  
Author(s):  
Anna Buckenmayer ◽  
Lotte Dahmen ◽  
Joachim Hoyer ◽  
Sahana Kamalanabhaiah ◽  
Christian S. Haas
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Renal Replacement Therapy ◽  
Kidney Disease ◽  
Renal Insufficiency ◽  
Replacement Therapy ◽  
Sedimentation Rate ◽  
Inflammatory Markers ◽  
Erythrocyte Sedimentation ◽  
Esrd Patients

Abstract Background: The erythrocyte sedimentation rate (ESR) is a simple laboratory diagnostic tool for estimating systemic inflammation. It remains unclear, if renal function affects ESR, thereby compromising its validity. This pilot study aims to compare prevalence and extent of ESR elevations in hospitalized patients with or without kidney disease. In addition, the impact of renal replacement therapy (RRT) modality on ESR was determined.Methods: In this single-center, retrospective study, patients were screened for ESR values. ESR was compared in patients with and without renal disease and/or RRT. In addition, ESR was correlated with other inflammatory markers, the extent of renal insufficiency and clinical characteristics.Results: A total of 203 patients was identified, showing an overall elevated ESR in the study population (mean 51.7±34.6 mm/h). ESR was significantly increased in all patients with severe infection, active vasculitis or cancer, respectively, independent from renal function. Interestingly, there was no difference in ESR between patients with and without kidney disease or those having received a prior renal transplant or being on hemodialysis. However, ESRD patients treated with peritoneal dialysis presented with a significantly higher ESR (78.3±33.1 mm/h, p<0.001), while correlation with other inflammatory markers was not persuasive.Conclusions: We showed that ESR: (1) does not differ between various stages of renal insufficiency; (2) may be helpful as a screening tool also in patients with renal insufficiency; and (3) is significantly increased in ESRD patients on peritoneal dialysis per se, while it seems not to be affected by hemodialysis or renal transplantation (see graphical abstract as supplementary material).

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