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anticoagulation renal replacement therapy

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https://www.readbyqxmd.com/read/28339843/availability-and-cost-of-extracorporeal-treatments-for-poisonings-and-other-emergency-indications-a-worldwide-survey
#1
Josée Bouchard, Valery Lavergne, Darren M Roberts, Monique Cormier, Genevieve Morissette, Marc Ghannoum
Background: Extracorporeal treatments (ECTRs) are used for different conditions, including replacement of organ function and poisoning. Current recommendations for ECTRs in various poisonings suggest that intermittent haemodialysis (IHD) is the most efficient technique. However, the practicality of these recommendations is poorly defined in view of limited information on availability and cost worldwide. Methods: A survey invitation to an Internet-based questionnaire was emailed between January 2014 and March 2015 to members of international societies to determine the availability, time to initiation and cost of ECTRs (including filters, dialysate, catheter, anticoagulant and nursing/physician salary)...
February 23, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28337077/antithrombin-iii-doses-rounded-to-available-vial-sizes-in-critically-ill-pediatric-patients
#2
Winifred M Stockton, Eimeira Padilla-Tolentino, Carolyn E Ragsdale
OBJECTIVES: Children have decreased levels of antithrombin III (AT III) compared to adults. These levels may be further decreased during acute illness. Administration of exogenous AT III can increase anticoagulant efficacy. The objective of this study was to evaluate AT III doses rounded to available vial sizes compared to partial vial doses in critically ill pediatric patients, including patients receiving extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT)...
January 2017: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
https://www.readbyqxmd.com/read/28284300/renal-replacement-therapy-in-acute-kidney-injury-controversies-and-consensus
#3
REVIEW
Michael Heung, Lenar Yessayan
Acute kidney injury (AKI) is a common complication among critically ill patents, and 5% of intensive care unit (ICU) patients require initiation of renal replacement therapy (RRT). In recent years, clinical trials have provided evidence-based guidance for some important aspects of RRT management in patients with AKI, such as dialysis dosing and approaches to anticoagulation in patients undergoing continuous RRT. However, there remain many areas of uncertainty, and delivery of RRT in the ICU requires clinical judgment, flexibility, and an understanding of dialysis principles...
April 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28254856/considerations-for-medication-management-and-anticoagulation-during-continuous-renal-replacement-therapy
#4
Ashley Thompson, Fanny Li, A Kendall Gross
Providing safe and high-quality care to critically ill patients receiving continuous renal replacement therapy (CRRT) includes adequate drug dosing and evaluation of patients' response to medications during therapy. Pharmacokinetic drug studies in acute kidney injury and CRRT are limited, considering the number of medications used in critical care. Therefore, it is important to understand the basic principles of drug clearance during CRRT by evaluating drug properties, CRRT modalities, and how they affect medication clearance...
2017: AACN Advanced Critical Care
https://www.readbyqxmd.com/read/28247082/membrane-pressures-predict-clotting-of-pediatric-continuous-renal-replacement-therapy-circuits
#5
Aadil Kakajiwala, Thomas Jemielita, John Z Hughes, Kimberly Windt, Michelle Denburg, Stuart L Goldstein, Benjamin Laskin
BACKGROUND: Clotting of continuous renal replacement therapy (CRRT) circuits leads to inadequate clearance, decreased ultrafiltration, and increased resource use. We identified factors associated with premature clotting of circuits during CRRT in children. METHODS: In a retrospective cohort of 26 children (median age 11.8 years) receiving 79 CRRT circuits (51 heparin, 22 citrate, 6 using no anticoagulation), we captured hourly pressure, flow, and fluid removal rates along with all activated clotting time (ACT) and circuit ionized calcium measurements...
March 1, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/28219324/non-anti-coagulant-factors-associated-with-filter-life-in-continuous-renal-replacement-therapy-crrt-a-systematic-review-and-meta-analysis
#6
Matthew Brain, Elizabeth Winson, Owen Roodenburg, John McNeil
BACKGROUND: Optimising filter life and performance efficiency in continuous renal replacement therapy has been a focus of considerable recent research. Larger high quality studies have predominantly focussed on optimal anticoagulation however CRRT is complex and filter life is also affected by vascular access, circuit and management factors. We performed a systematic search of the literature to identify and quantify the effect of vascular access, circuit and patient factors that affect filter life and presented the results as a meta-analysis...
February 20, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28219057/preventing-continuous-renal-replacement-therapy-induced-hypophosphatemia-an-extended-clinical-experience-with-a-phosphate-containing-solution-in-the-setting-of-regional-citrate-anticoagulation
#7
Valentina Pistolesi, Laura Zeppilli, Francesca Polistena, Maria Itala Sacco, Alessandro Pierucci, Luigi Tritapepe, Giuseppe Regolisti, Enrico Fiaccadori, Santo Morabito
AIMS: To evaluate the efficacy and safety of a commercially available phosphate-containing solution for continuous renal replacement therapy (CRRT) in preventing CRRT-related hypophosphatemia. METHODS: In heart surgery patients undergoing continuous veno-venous haemodiafiltration (CVVHDF) with regional citrate anticoagulation (RCA), we combined an 18 mmol/l citrate solution with a phosphate-containing (1.2 mmol/l) dialysate/replacement fluid evaluating the incidence of hypophosphatemia and the need for parenteral phosphorus supplementation...
February 21, 2017: Blood Purification
https://www.readbyqxmd.com/read/28197045/experiences-with-continuous-venovenous-hemofiltration-using-18mmol-l-predilution-citrate-anticoagulation-and-a-phosphate-containing-replacement-solution
#8
Yuen Henry Jeffrey, Shum Hoi-Ping, Anne Leung Kit Hung, Lam Chung-Ling, Yan Wing-Wa, Lai King-Yiu
CONTEXT: Regional citrate anticoagulation for continuous renal replacement therapy is associated with a longer filter-life, less bleeding events and improved mortality. Problems associated with using Prismocitrate 10/2 solution in continuous renal replacement therapy, include hypomagnesemia, hypophosphatemia and the need for additional bicarbonate infusion. AIMS: This study uses the new Prismocitrate 18/0 solution for improved buffer balance and Phoxilium solution for a more favourable electrolyte profile...
January 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28164512/critical-deviations-of-ionized-calcium-measurements-when-using-blood-gas-analyzers-to-monitor-citrate-dialysis
#9
Thorsten Feldkamp, Norbert Weiler, Michael Marx, Peter B Luppa, Ralf Junker
BACKGROUND: During the course of acute kidney injury (AKI) patients may require renal replacement therapy (RRT). The preferred therapeutic measure for such patients is continuous RRT (CRRT). Anticoagulation is required to prevent clotting of the extracorporeal circuit. The actual KDIGO guidelines recommend citrate as the first line anticoagulant. METHODS: Citrate dose infused into the extracorporeal circuit should achieve an extracorporeal calcium concentration of 0...
October 1, 2016: Clinical Laboratory
https://www.readbyqxmd.com/read/28138736/the-intensive-care-medicine-agenda-on-acute-kidney-injury
#10
REVIEW
Peter Pickkers, Marlies Ostermann, Michael Joannidis, Alexander Zarbock, Eric Hoste, Rinaldo Bellomo, John Prowle, Michael Darmon, Joseph V Bonventre, Lui Forni, Sean M Bagshaw, Miet Schetz
Acute kidney injury (AKI) is a common complication in the critically ill. Current standard of care mainly relies on identification of patients at risk, haemodynamic optimization, avoidance of nephrotoxicity and the use of renal replacement therapy (RRT) in established AKI. The detection of early biomarkers of renal tissue damage is a recent development that allows amending the late and insensitive diagnosis with current AKI criteria. Increasing evidence suggests that the consequences of an episode of AKI extend long beyond the acute hospitalization...
January 30, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28122702/major-publications-in-the-critical-care-pharmacotherapy-literature-in-2015
#11
Adrian Wong, Michael Erdman, Drayton A Hammond, Tara Holt, Jenna M Holzhausen, Michelle Horng, Lori Lynn Huang, Jennifer Jarvis, Bridgette Kram, Shawn Kram, Christine Lesch, Jessica Mercer, Megan A Rech, Ryan Rivosecchi, Brian Stump, Colleen Teevan, Sarah Day
PURPOSE: Recently published practice guidelines and research reports on pharmacotherapy in critical care patient populations are summarized. SUMMARY: The Critical Care Pharmacotherapy Literature Update (CCPLU) Group is composed of over 50 experienced critical care pharmacists who evaluate 31 peer-reviewed journals monthly to identify literature pertaining to pharmacotherapy in critical care populations. Articles are chosen for summarization in a monthly CCPLU Group publication on the basis of applicability and relevance to clinical practice and strength of study design...
March 1, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/28118627/prostacyclin-as-an-anticoagulant-for-continuous-renal-replacement-therapy-in-children
#12
Akash Deep, Mohammad Zoha, Pompa Dutta Kukreja
Effective delivery of continuous renal replacement therapy (CRRT) depends on the longevity of the filter and circuit used in the CRRT machine. Safe and effective anticoagulation is crucial for maintaining the patency of these circuits. In children, heparin and citrate are the commonly used anticoagulants but they are limited by serious side effects and thus calls for meticulous monitoring. In conditions where neither of these can be used, prostacyclin can be an effective alternative. Prostacyclin is a platelet inhibitor that can be safely used as an efficient anticoagulant in CRRT...
January 25, 2017: Blood Purification
https://www.readbyqxmd.com/read/28070667/erratum-to-regional-citrate-anticoagulation-for-continuous-renal-replacement-therapy-in-children
#13
Mayerly Prada Rico, Jaime Fernández Sarmiento, Ana María Rojas Velasquez, Luz Stella González Chaparro, Ricardo Gastelbondo Amaya, Hernando Mulett Hoyos, Daniel Tibaduiza, Ana Maria Quintero Gómez
No abstract text is available yet for this article.
January 9, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/28058458/-vitamin-k-antagonists-is-their-prescription-really-medical-malpractice-%C3%A2-today
#14
E Rafflenbeul, J Müller-Ehmsen
Atrial fibrillation and venous thromboembolisms are frequent cardiovascular diseases. Until a few years ago only vitamin K antagonists (VKA) were available for oral anticoagulation as primary and secondary prevention of thrombembolic events. Currently, the non-vitamin K dependent new oral anticoagulants (NOAC) dabigatran, rivaroxaban, apixaban and edoxaban are approved for use. The approval studies, meta-analyses and data from registries provide evidence for the superiority of NOAC vs. VKA with respect to reduction of thrombembolisms and reduced bleeding complications; therefore, in the 2016 European Society of Cardiology (ESC) guidelines the use of NOAC is recommended as first line therapy for anticoagulation in atrial fibrillation (recommendation grade I/evidence level A)...
January 2017: Der Internist
https://www.readbyqxmd.com/read/28044236/vascular-adhesion-protein-1-in-hemodialysis-and-hemodiafiltration-patients-effect-of-single-hemodialysis-session-on-its-level-in-regard-to-type-of-anticoagulant
#15
Jolanta Malyszko, Ewa Koc-Zorawska, Piotr Kozminski, Jacek S Malyszko
PURPOSE: Traditional anticoagulants used in intermittent hemodialysis (HD) are unfractionated heparin (UFH) and increasingly low molecular weight heparins (LMWHs). Repeated and prolonged exposure to UFH and/or LMWHs may further disturb hemostasis in uremic patients. Vascular adhesion protein-1 (VAP-1) is secreted by vascular smooth muscle cells, adipocytes and endothelial cells with functional monoamine oxidase activity and is elevated in atherosclerosis, diabetes mellitus and obesity...
January 2, 2017: International Urology and Nephrology
https://www.readbyqxmd.com/read/27926465/freestyle-stentless-bioprosthesis-for-aortic-valve-therapy-17-year-clinical-results
#16
Juergen Ennker, Markus Meilwes, Joern Pons-Kuehnemann, Bernd Niemann, Philippe Grieshaber, Ina C Ennker, Andreas Boening
BACKGROUND: Aortic valve replacement with stentless bioprostheses has been shown to produce lower aortic gradients than stented bioprostheses, thus facilitating left ventricular mass regression and preventing heart failure. We sought to determine the long-term results of stentless biological aortic valve replacement over a 17-year follow-up. METHODS: Between 1996 and 2012, 2551 patients underwent isolated aortic valve replacement with a stentless prosthesis (Medtronic Freestyle) at a single center...
November 2016: Asian Cardiovascular & Thoracic Annals
https://www.readbyqxmd.com/read/27913748/a-3-year-follow-up-of-a-patient-with-acute-renal-failure-caused-by-thrombotic-microangiopathy-related-to-antiphospholipid-syndrome-case-report
#17
X-J Zhou, M Chen, S-X Wang, F-D Zhou, M-H Zhao
BACKGROUND: Microvascular manifestations of antiphospholipid antibody syndrome in the kidneys include acute renal failure, thrombotic microangiopathy and hypertension. Therapy has been largely empiric. CASE REPORT: A 49-year-old Chinese man presented with anuric acute renal failure without abundant proteinuria and heavy haematuria, but markedly low levels of urinary sodium, potassium and chlorine upon admission. On day 1 of hospitalization, his thrombocytopenia, anaemia and renal failure showed rapid progression...
December 2, 2016: Lupus
https://www.readbyqxmd.com/read/27896442/regional-citrate-anticoagulation-for-continuous-renal-replacement-therapy-in-children
#18
Mayerly Prada Rico, Jaime Fernández Sarmiento, Ana María Rojas Velasquez, Luz Stella González Chaparro, Ricardo Gastelbondo Amaya, Hernando Mulett Hoyos, Daniel Tibaduiza, Ana Maria Quintero Gómez
BACKGROUND: Anticoagulation of the continuous renal replacement therapy (CRRT) circuit is an important technical aspect of this medical procedure. Most studies evaluating the efficacy and safety of citrate use have been carried out in adults, and little evidence is available for the pediatric patient population. The aim of this study was to compare regional citrate anticoagulation versus systemic heparin anticoagulation in terms of the lifetime of hemofilters in a pediatric population receiving CRRT at a pediatric center in Bogota, Colombia...
November 28, 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/27866200/implementation-of-a-simplified-regional-citrate-anticoagulation-protocol-for-post-dilution-continuous-hemofiltration-using-a-bicarbonate-buffered-calcium-containing-replacement-solution
#19
Christopher J Kirwan, Ross Hutchison, Sherif Ghabina, Stephanie Schwarze, Abigail Beane, Susan Ramsay, Edward Thompson, John R Prowle
BACKGROUND/AIMS: Recent updates to the Nikkiso Aquarius continuous renal replacement therapy (CRRT) platform allowed us to develop a post-dilution protocol for regional citrate anticoagulation (RCA) using standard bicarbonate buffered, calcium containing replacement solution with acid citrate dextrose formula-A as a citrate source. Our objective was to demonstrate that the protocol was safe and effective. METHODS: Prospective audit of consecutive patients receiving RCA for CRRT within intensive care unit, who were either contraindicated to heparin or had poor filter lifespan (<12 h for 2 consecutive filters) on heparin...
2016: Blood Purification
https://www.readbyqxmd.com/read/27852414/-survey-of-continuous-renal-replacement-therapy-application-status
#20
C S Yang, Y Yang, L W Huang, X W Zhang, S Q Liu, H B Qiu
Objective: To investigate the condition of implementation of continuous renal replacement therapy (CRRT) in quality control center of critical care medicine. Methods: Questionnaire mails were issued to all of the quality control respondents to survey the application of CRRT in June 2015 from Jiangsu quality control center of critical care medicine. Results: Among the 69 quality control respondents, 62 were equipped with CRRT devices, and in 58 of which patients were treated with CRRT. There were 195 doctors and 253 nurses in 62 quality control respondents attended CRRT training at or above the provincial level; the proportions of hospitals in southern, central and northern regions of Jiangsu were 63%, 79% and 86% respectively with trained doctors (more than 2), and 34%, 38% and 43% respectively with trained nurses (more than 3)...
October 25, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
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