scholarly journals Effect of Dynamic Circuit Pressures Monitoring on the Lifespan of Extracorporeal Circuit and the Efficiency of Solute Removal During Continuous Renal Replacement Therapy

2021 ◽  
Vol 8 ◽  
Author(s):  
Peiyun Li ◽  
Ling Zhang ◽  
Li Lin ◽  
Xin Tang ◽  
Mingjing Guan ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Cox Regression ◽  
Dynamic Pressure ◽  
Regional Citrate Anticoagulation ◽  
Extracorporeal Circuit ◽  
Cox Regression Analysis ◽  
Extracorporeal Circuits ◽  
Removal Efficiencies

Objective: To observe the effects of dynamic pressure monitoring on the lifespan of the extracorporeal circuit and the efficiency of solute removal during continuous renal replacement therapy (CRRT).Materials and Methods: A prospective observational study was performed at the West China Hospital of Sichuan University in the ICU. Analyses of the downloaded pressure data recorded by CRRT machines and the solute removal efficiencies, calculated by 2*Ce/(Cpre+Cpost), where Ce, Cpre, and Cpost are the concentrations of the effluent, pre-filter blood, and post-filter blood, respectively, were performed. Samples were collected at 0, 2, 6, 12, and 24 h when continuous veno-venous hemodiafiltration (CVVHDF) was used after the initiation of CRRT. Measurements in concentrations of creatinine, blood urea nitrogen, and β2-microglobulin in the plasma and effluent were recorded.Results: Extracorporeal circuits characterized by moderate-to-severe (M–S) access outflow dysfunction (AOD) events, defined as access outflow pressure less than or equal to −200 mmHg for more than 5 min, had shorter median lifespans with no anticoagulation (32.3 vs. 10.90 h, P = 0.001) compared with the no M–S AOD events group. The significant outcome also existed in regional citrate anticoagulation (RCA) (72 vs. 42.47 h, P = 0.02). Moreover, Cox regression analysis revealed that the lack of M–S AOD events, RCA, or CVVHDF independently prolonged the circuit lifespan. All tested solutes removal efficiencies started to decline at 12 h. Furthermore, efficiencies of all solutes removal dropped obviously at 24 h when TMP ≥ 150 mmHg.Conclusion: RCA and CVVHDF predicted a longer circuit lifespan. M–S AOD events were associated with a shorter circuit lifespan when RCA or no anticoagulant was used. Replacement of extracorporeal circuit could be considered when running time of filter lasted up to 24 h with TMP ≥ 150 mmHg.

scholarly journals Effect of Dynamic Circuit Pressures Monitoring on the Lifespan of Extracorporeal Circuit and the Efficiency of Solute Removal During Continuous Renal Replacement Therapy

2020 ◽  
Author(s):  
Peiyun Li ◽  
Ling Zhang ◽  
Li Lin ◽  
Xin Tang ◽  
Mingjing Guan ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Cox Regression ◽  
Dynamic Pressure ◽  
Regional Citrate Anticoagulation ◽  
Extracorporeal Circuit ◽  
Cox Regression Analysis ◽  
Extracorporeal Circuits ◽  
Removal Efficiencies

Abstract Objective: To observe the effects of dynamic pressure monitoring on the lifespan of the extracorporeal circuit and the efficiency of solute removal during continuous renal replacement therapy (CRRT).Materials and Methods: A prospective observational study was performed at the West China Hospital of Sichuan University in the intensive care unit. Analyses of the downloaded pressure data recorded by CRRT machines and the solute removal efficiencies, calculated by 2*Ce/(Cpre+Cpost), where Ce, Cpre and Cpost are the concentrations of the effluent, pre-filter blood, and post-filter blood, respectively, were performed. Samples were collected at 0, 2, 6, 12, 24 h after the initiation of CRRT. We measured the concentrations of creatinine, blood urea nitrogen (BUN) and β2-microglobulin in the plasma and effluent.Results: Extracorporeal circuits characterized by moderate-severe (M-S) access outflow dysfunction (AOD) events, defined as access outflow pressure less than or equal to -200 mm Hg more than 5mins, had shorter lifespans with no anticoagulation (17.6±11.2 h vs. 35.1±17.1 h, P=0.001) or with regional citrate anticoagulation (RCA) (40.3±22.2 h vs. 55.9±21.7 h, P=0.016). Moreover, Cox regression analysis revealed that the lack of moderate-severe AOD events, RCA, or continuous veno-venous hemodiafiltration (CVVHDF) independently prolonged the circuit lifespan. All tested solutes removal efficiencies started to decline at 12h. Furthermore, efficiencies of all solutes removal dropped obviously at 24h when TMP≥ 150mmHg.Conclusion: RCA and CVVHDF predicted a longer circuit lifespan. Moderate-severe AOD events were associated with a shorter circuit lifespan when RCA or no anticoagulation was used. Replacement of extracorporeal circuit might be considered if TMP≥ 150mmHg at 24h.

Prognostic Factors and Efficacy for Continuous Renal Replacement Therapy in Critically Ill Patients: A Chinese Single-Center Retrospective Study

2017 ◽  
Vol 45 (1-3) ◽  
pp. 53-60
Author(s):  
Jing Zhang ◽  
Yiming Li ◽  
Zhiyong Peng
Keyword(s):  
Prognostic Factors ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Cox Regression ◽  
Demographic Data ◽  
Vital Signs ◽  
Binary Logistic Regression ◽  
Practice Variation ◽  
Cox Regression Analysis

Background: There is controversy about the efficacy and prognostic factors for continuous renal replacement therapy (CRRT) in China due to practice variation. Our aim is to investigate these questions. Method: A total of 613 adult patients receiving CRRT in last 3 years from one Chinese ICU were enrolled. The analysis of demographic data, vital signs, and laboratory tests prior to CRRT and outcomes were performed. The data between pre- and post-CRRT were compared for efficacy analysis. Results: Prior to CRRT, partial pressure of carbon dioxide (PCO2), systolic blood pressure (SBP), gender, age, bilirubin, cystatin C, and mechanical ventilation were correlated with in-hospital mortality. In a binary logistic regression, PCO2, SBP, age, and gender were significant in predicting mortality. Cox regression analysis demonstrated PCO2 independent association with mortality, and lower SBP worse mortality. CRRT could eliminate the fluid and metabolites. Conclusion: CO2 retention and low SBP prior to CRRT were associated with increased mortality. CRRT significantly improved hemeostasis.

Higher versus Lower Continuous Renal Replacement Therapy Intensity in Critically ill Patients with Liver Dysfunction

2017 ◽  
Vol 45 (1-3) ◽  
pp. 36-43 ◽  
Author(s):  
Zachary O'Brien ◽  
Alan Cass ◽  
Louise Cole ◽  
Simon Finfer ◽  
Martin Gallagher ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Liver Dysfunction ◽  
Critically Ill Patients ◽  
Cox Regression ◽  
Lower Intensity ◽  
Cox Regression Analysis ◽  
Lower Continuous

Aims: To study the association between higher versus lower continuous renal replacement therapy (CRRT) intensity and mortality in critically ill patients with combined acute kidney injury and liver dysfunction. Methods: Post-hoc analysis of patients with liver dysfunction (Sequential Organ Failure Assessment liver score ≥2 or diagnosis of liver failure/transplant) included in the Randomized Evaluation of Normal versus Augmented Level renal replacement therapy (RENAL) trial. Results: Of 444 patients, 210 (47.3%) were randomized to higher intensity (effluent flow 40 mL/kg/h) and 234 (52.7%) to lower intensity (effluent flow 25 mL/kg/h) therapy. Overall, 79 and 86% of prescribed effluent flow was delivered in the higher-intensity and lower-intensity groups, respectively (p < 0.001). In total, 113 (54.1%) and 120 (51.3%) patients died in each group. On multivariable Cox regression analysis, we found no independent association between higher CRRT intensity and mortality (HR 0.93, 95% CI 0.70-1.24; p = 0.642). Conclusions: In RENAL patients with liver dysfunction, higher CRRT intensity was not associated with reduced mortality.

scholarly journals Practical issues of regional anticoagulation during continuous renal replacement therapy

2019 ◽  
Author(s):  
Dariusz Onichimowski ◽  
Joanna Maria Wolska ◽  
Radosław Borysiuk ◽  
Marcin Mieszkowski ◽  
Zuzanna Stępień ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Blood Purification ◽  
Bleeding Complications ◽  
Regional Citrate Anticoagulation ◽  
Extracorporeal Circuit ◽  
Extracorporeal Blood ◽  
Extracorporeal Blood Purification ◽  
Regional Anticoagulation

Introduction: Extracorporeal blood purification techniques have become a well-established part of routine practice in intensive care units. The issue of major concern while applying these techniques is to ensure appropriate anticoagulation to prevent the clotting of the circuit. Aim: The aim of this paper is to present regional anticoagulation as a method which is currently used in continuous extracorporeal blood purification techniques. Material and methods: This work is based on the available literature and the authors’ experience. Results and discussion: Anticoagulation used to prevent the clotting of the circuit in extracorporeal blood purification techniques may be regional or systemic. Regional anticoagulation inhibits clotting only in the extracorporeal circuit. In this case either sodium citrate together with calcium substitution or heparin with protamine sulfate is used. Systemic anticoagulation involves the inhibition of clotting in the extracorporeal circuit and in the patient’s body. Regional citrate anticoagulation (RCA) is obtained with the use of citrate. With this technique calcium substitution is necessary in order to prevent hypocalcemia. Other possible complications include alkalosis, metabolic acidosis, hypercalcemia and hypomagnesemia. This paper presents also some practical aspects of regional anticoagulation during continuous renal replacement therapy (CRRT) Conclusions: The application of RCA has contributed to a wider use of CRRT in intensive therapy units. The greatest advantage of this method is almost complete elimination of bleeding complications associated with the therapy. It enables effective blood purification in the patients in whom the use of heparins is contraindicated. This fact has found confirmation in Kidney Disease: Improving Global Outcomes (KDIGO) guidelines.

Clinical Impact of Regional Citrate Anticoagulation in Continuous Renal Replacement Therapy in Critically Ill Patients

2017 ◽  
Vol 40 (12) ◽  
pp. 676-682 ◽  
Author(s):  
Maria Huguet ◽  
Lida Rodas ◽  
Miquel Blasco ◽  
Luis F. Quintana ◽  
Jordi Mercadal ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Red Blood Cell Transfusion ◽  
Regional Citrate Anticoagulation ◽  
Transfusion Rate ◽  
Metabolic Disturbances ◽  
Heparin Group ◽  
Metabolic Complications ◽  
Citrate Anticoagulation

Background Regional citrate anticoagulation (RCA) is being used increasingly in continuous renal replacement therapy (CRRT) as a safer alternative to heparin. However, complex metabolic control to avoid side effects have generated discrepancies about its introduction into everyday practice. We aimed to compare both anticoagulation techniques in terms of efficacy, safety and feasibility. Methods Observational retrospective study performed in 3 specialized ICUs in patients receiving CVVHDF with RCA between January 2013 and May 2016. Heparin-treated patients matched by age, sex and disease severity treated in the preceding year were selected as historic controls. Filter lifetime, number of filters used, haemorrhagic complications and metabolic complications were recorded. Results 54 patients (27 treated with RCA and 27 with heparin) were included in the study. Filter lifetimes in the first 72 hours were 55.1 ± 21.8 hours in the RCA group compared to 38.8 ± 24.8 hours in the heparin group, (p = 0.004). In addition, the number of filters used in the first 72 hours was significantly higher in the heparin group (2.4 ± 1.3 vs. 1.5 ± 0.7; p = 0.004). There was a trend toward a lower incidence of bleeding in the RCA group, with a significantly lower red blood cell transfusion rate (p = 0.027) in the citrate group. No clinically significant metabolic disturbances were observed in the RCA group. Regarding outcomes, there were no significant differences between groups. Conclusions These results suggest that the implementation of CVVHDF with RCA using concentrated citrate solutions prolongs filter lifetime, achieves a longer effective hemodiafiltration time and is a safe and feasible method.

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