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Continuous renal replacement therapy

Theresa A Mottes, Stuart L Goldstein, Rajit K Basu
BACKGROUND: The prevalence of continuous renal replacement therapy (CRRT) utilization in critically ill patients with acute kidney is increasing. In comparison to published and on-going trials attempting to answer questions surrounding the optimal timing of CRRT initiation, anticoagulation, and modality, a paucity of literature describes the quality of the therapy delivered. METHODS: We conducted a single-center process improvement project to determine if a methodology to assess the quality of CRRT delivery could lead to improvement in CRRT delivery outcomes...
January 11, 2019: BMC Nephrology
Panagiotis Kompotiatis, Brandon M Wiley, Jacob C Jentzer, Kianoush B Kashani
MAIN OBJECTIVES: Echocardiographic parameters have been used to predict outcomes for specific intensive care unit (ICU) populations. We sought to define echocardiographic parameters for ICU patients receiving continuous renal replacement therapy (CRRT). DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: This is a historical cohort study of consecutive ICU patients at Mayo Clinic (Rochester, Minnesota) who received CRRT from December 9, 2006, through November 13, 2015...
2019: PloS One
Tenorio-Cañamás Teresa, Grau Santiago, Luque Sonia, Fortún Jesús, Liaño Fernando, Roberts Jason A
BACKGROUND: An optimal antifungal therapy for invasive candidiasis in critically ill patients is essential to reduce the high mortality rates. Acute kidney injury is common and continuous renal replacement therapies are frequently used. Previous studies have demonstrated a lack of effect from different continuous renal replacement techniques on micafungin clearance. However, the use of high cut-off pore size membranes could potentially allow the loss of albumin and alter micafungin pharmacokinetics...
January 9, 2019: Therapeutic Drug Monitoring
Raymond Vanholder, Vianda S Stel, Kitty J Jager, Norbert Lameire, Fiona Loud, Rainer Oberbauer, Rianne W de Jong, Carmine Zoccali
Kidney transplantation offers better outcomes and quality of life at lower societal costs compared with other options of renal replacement therapy. In this review of the European Kidney Health Alliance, the current status of kidney transplantation throughout Europe and suggestions for improvement of transplantation rates are reported. Although the European Union (EU) has made considerable efforts in the previous decade to stimulate transplantation activity, the discrepancies among European countries suggest that there is still room for improvement...
January 9, 2019: Nephrology, Dialysis, Transplantation
Sanwang Li, Feifan Xie
Various dose regimens of imipenem have been prescribed in critically ill patients undergoing continuous renal replacement therapy (CRRT) but there are limited information on its pharmacokinetics (PK) and treatment efficacy. The aim of this study was to describe the population PK of imipenem in patients receiving CRRT, and utilize this model to inform optimal dosing regimens using pharmacokinetics/pharmacodynamics (PK/PD) target as a surrogate marker for treatment efficacy. Population PK modelling was undertaken in 20 patients receiving CRRT to characterize variabilities and identify influential covariates...
January 2019: International Journal of Antimicrobial Agents
Sedef Tavukcu Ozkan, Harun Arbatli
Close hemodynamic monitoring is crucial for the patients to guide cardiovascular therapy for the optimal management. Transpulmonary thermodilution offers a less invasive hemodynamic monitoring with Pulse Index Continuous Cardiac Output system analysis. Intracardiac shunts have been associated with well-defined alterations in transpulmonary thermodilution-related hemodynamic parameters leading to inaccurate measurements and therefore are among the contraindications for transpulmonary thermodilution. However, data on the effects of arteriovenous fistulas as well as extracorporeal circuits on the thermodilution curves remain limited and inconclusive...
January 4, 2019: Journal of Vascular Access
Moon Seong Baek, Sang-Min Lee, Chi Ryang Chung, Woo Hyun Cho, Young-Jae Cho, Sunghoon Park, So-My Koo, Jae-Seung Jung, Seung Yong Park, Youjin Chang, Byung Ju Kang, Jung-Hyun Kim, Jin Young Oh, So Hee Park, Jung-Wan Yoo, Yun Su Sim, Sang-Bum Hong
BACKGROUND: Although the utilization of extracorporeal membrane oxygenation (ECMO) is increasing and its technology is evolving, only a few epidemiologic reports have described the uses and outcomes of ECMO. The aim of this study was to investigate the changes in utilization and survival rate in patients supported with ECMO for severe respiratory failure in Korea. METHODS: This was a multicenter study on consecutive patients who underwent ECMO across 16 hospitals in Korea...
January 3, 2019: Critical Care: the Official Journal of the Critical Care Forum
Yoshihiro Tange, Shigenori Yoshitake
Continuous renal replacement therapy (CRRT) maintains a balance in body water and electrolytes. CRRT supplies a higher quantity of fluid than intravenous fluid therapy along with simultaneous fluid withdrawal. We hypothesized that use of a high-oxygen-containing solution for high-volume fluid exchange would improve oxygenation in the blood during CRRT. To start with, we prepared a solution containing high oxygen. The objective of this study was to determine if this solution would increase the partial pressure of oxygen (pO2 ) in the blood more than that using a conventional solution during CRRT...
January 2, 2019: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
Ping He, Shixin Zhang, Bingyang Hu, Wei Wu
Background: Patients undergoing extracorporeal membrane oxygenation (ECMO) treatment often have severe fluid overload and electrolyte imbalances and may even suffer acute kidney injury (AKI). It is often necessary to use continuous renal replacement therapy (CRRT). In this study, we aimed to retrospectively analyze the prognosis of patients treated with ECMO combined with CRRT and to find the independent factors that affect the survival rate. Methods: There were 32 patients who were treated with ECMO combined with CRRT in our hospital from January 2007 to December 2017 who were analyzed...
December 2018: Annals of Translational Medicine
Javier A Neyra, Victor M Ortiz-Soriano, Dina Ali, Peter E Morris, Clayton M Johnston
Introduction: Hyponatremia is a common electrolyte disorder in critically ill patients. Rapid correction of chronic hyponatremia may lead to osmotic demyelination syndrome. Management of severe hyponatremia in patients with acute or chronic kidney disease who require continuous renal replacement therapy (CRRT) is limited by the lack of commercially available hypotonic dialysate or replacement fluid solutions. Methods: This was a single-center quality improvement project that consisted of the development and implementation of a multidisciplinary protocol for gradual correction of severe hyponatremia in patients who were admitted to the intensive care unit (ICU) and required CRRT...
January 2019: KI Reports
Makito Miyake, Takuya Owari, Shunta Hori, Yasushi Nakai, Kiyohide Fujimoto
Urothelial carcinoma (UC) arises extensively from the renal pelvis, ureter, urinary bladder, and urethra. UC represents a clinical and social challenge because of its incidence, post-treatment recurrence rate, and prognosis. Combinations of urine cytology, cystoscopy, and conventional imaging such as computed tomography are currently used for diagnosis and monitoring modalities of UC. Both the poor diagnostic accuracy of urine cytology and poor cost performance of cystoscopy and conventional imaging modalities emphasize the urgent need for advancement in clinical guidance for UC...
2018: Research and Reports in Urology
Benjamin R Griffin, Anna Jovanovich, Zhiying You, Paul Palevsky, Sarah Faubel, Diana Jalal
OBJECTIVES: Thrombocytopenia is common in critically ill patients with severe acute kidney injury and may be worsened by the use of renal replacement therapy. In this study, we evaluate the effects of renal replacement therapy on subsequent platelet values, the prognostic significance of a decrease in platelets, and potential risk factors for platelet decreases. DESIGN: Post hoc analysis of the Acute Renal Failure Trial Network Study. SETTING: The Acute Renal Failure Trial Network study was a multicenter, prospective, randomized, parallel-group trial of two strategies for renal replacement therapy in critically ill patients with acute kidney injury conducted between November 2003 and July 2007 at 27 Veterans Affairs and university-affiliated medical centers...
December 21, 2018: Critical Care Medicine
Elena Zakharova
Background: The anatomy and physiology of kidneys as well as kidney diseases have been studied in Russia since the 18th century. However, there was a surge in interest in the 1920s, with numerous researchers and clinicians making substantial advances in the understanding of the pathophysiology, pathology, and diagnostics of kidney diseases. The field of nephrology as clinical practice can be traced back to 1957-1958, when the first beds for patients with kidney diseases became available and the first hemodialysis procedure was performed...
November 2018: Kidney Diseases
Marceli Lukaszewski, Kinga Kosiorowska, Dorota Kaminska, Marta Obremska, Oktawia Mazanowska, Magdalena Krajewska
BACKGROUND: Lupus nephritis (LN) is one of the most common manifestations of systemic lupus erythematosus (SLE) and is often the most serious organ complication and the cause of premature death of such a patient. Most of other organs and systems can be also affected. A typical complication is a cardiovascular involvement leading to the development of heart failure. According to current therapeutic standards, kidney transplantation is the treatment of choice in patients with renal failure in course of LN...
December 20, 2018: BMC Nephrology
Joop Jonckheer, Klaar Vergaelen, Herbert Spapen, Manu L N G Malbrain, Elisabeth De Waele
INTRODUCTION: Nutrition is an important part of treatment in critically ill children. Clinical guidelines for nutrition adaptations during continuous renal replacement therapy (CRRT) are lacking. We collected and evaluated current knowledge on this topic and provide recommendations. METHODS: Questions were produced to guide the literature search in the PubMed database. RESULTS: Evidence is scarce and extrapolation from adult data was often required...
December 20, 2018: Nutrition in Clinical Practice
Soo Jin Na, Hee Jung Choi, Chi Ryang Chung, Yang Hyun Cho, Hye Ryoun Jang, Gee Young Suh, Kyeongman Jeon
BACKGROUND: The introduction of a continuous renal replacement therapy (CRRT) device into the extracorporeal membrane oxygenation (ECMO) circuit is widely used. However, excessive pressure transmitted to the CRRT device is a major disadvantage. We investigated the effects of using additional pressure control lines on the pressure and the lifespan of the CRRT circuit connected to the ECMO. METHODS: This is an observational study using prospectively collected data from consecutive patients receiving CRRT connected into the ECMO circuit at a university-affiliated, tertiary hospital from January 2013 to December 2016...
December 19, 2018: BMC Nephrology
Wang Chen, Yue Zhou, Zili Kong, Xiang Wang, Wenshan Lv, Zhuang Geng, Yangang Wang
AIMS: We undertook a systematic review and meta-analysis to assess the efficacy and safety of Sodium-Glucose cotransporter 2 inhibitors (SGLT2is) on kidney outcomes in patients with type 2 diabetes mellitus (T2DM) with or without prevalent kidney disease. MATERIALS AND METHODS: PubMed, Web of science, Embase and the Cochrane Library were systematically searched for randomized controlled trials (RCTs) to assess the efficacy and safety of SGLT2is treatment versus placebo in T2DM...
December 18, 2018: Diabetes, Obesity & Metabolism
Alicia Isabel I Fayad, Daniel G Buamscha, Agustín Ciapponi
BACKGROUND: Acute kidney injury (AKI) is a common condition among patients in intensive care units (ICUs), and is associated with high death. Renal replacement therapy (RRT) is a blood purification technique used to treat the most severe forms of AKI. The optimal time to initiate RRT so as to improve clinical outcomes remains uncertain.This review complements another Cochrane review by the same authors: Intensity of continuous renal replacement therapy for acute kidney injury. OBJECTIVES: To assess the effects of different timing (early and standard) of RRT initiation on death and recovery of kidney function in critically ill patients with AKI...
December 18, 2018: Cochrane Database of Systematic Reviews
A Broeker, S G Wicha, C Dorn, A Kratzer, M Schleibinger, F Kees, A Heininger, M G Kees, H Häberle
BACKGROUND: Tigecycline is a vital antibiotic treatment option for infections caused by multiresistant bacteria in the intensive care unit (ICU). Acute kidney injury (AKI) is a common complication in the ICU requiring continuous renal replacement therapy (CRRT), but pharmacokinetic data for tigecycline in patients receiving CRRT are lacking. METHODS: Eleven patients mainly with intra-abdominal infections receiving either continuous veno-venous hemodialysis (CVVHD, n = 8) or hemodiafiltration (CVVHDF, n = 3) were enrolled, and plasma as well as effluent samples were collected according to a rich sampling schedule...
December 17, 2018: Critical Care: the Official Journal of the Critical Care Forum
Christina König, Anka C Röhr, Otto R Frey, Alexander Brinkmann, Jason A Roberts, Dominic Wichmann, Stephan Braune, Stefan Kluge, Axel Nierhaus
OBJECTIVES: The aim of this study is to describe the in vitro adsorption of anti-infective drugs onto an extracorporeal cytokine adsorber. METHODS: Various anti-infective drugs (β-lactams, quinolones, aminoglycosides, glycopeptides, azole antimycotics) were prepared in normal saline 0.9% and human albumin 5%, and pumped through a cytokine cartridge (CytoSorb® ; CytoSorbents Corporation, Monmouth Junction, NJ, USA) at a flow rate of 1.2 L/h for 1.5 h. In addition, meropenem and ciprofloxacin were dissolved in reconstituted blood and run through a CytoSorb cartridge, which was integrated into a continuous renal replacement therapy circuit with a flow rate of 2 L/h for 18 h...
December 13, 2018: International Journal of Artificial Organs
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