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anticoagulation renal replacement therapy

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https://www.readbyqxmd.com/read/29788836/intracranial-hemorrhage-in-adults-on-ecmo
#1
Yiorgos Alexandros Cavayas, Lorenzo Del Sorbo, Eddy Fan
RATIONALE: Extracorporeal membrane oxygenation (ECMO) use has exploded over the last decade. However, it remains invasive and associated with significant complications, including tamponade, infection, thrombosis, gas embolism and bleeding. The most dreaded complication is intracranial hemorrhage (ICH). In this article, we review the literature on the incidence, diagnosis, risk factors, pathophysiology, prognosis, prevention and management of ICH in adults on ECMO. MAIN FINDINGS: We found a high incidence of ICH in the literature with a poor prognosis...
May 2018: Perfusion
https://www.readbyqxmd.com/read/29745004/heparin-free-renal-replacement-therapy-for-chronic-hemodialyzed-patients-at-high-risk-for-bleeding-a-comparison-of-on-line-predilution-hemodiafiltration-with-conventional-hemodialysis
#2
Vincent Brunot, Jean-Emmanuel Serre, Georges Mourad, Kada Klouche, Vincent Pernin
BACKGROUND: In chronic hemodialysis patients with high risk of bleeding, optimal anticoagulation of the extracorporeal circuit is challenging. Heparin-free hemodialysis (HD) with heparin-coated AN69ST dialyzer is now considered as a good option and recommended by experts. Predilutional hemodiafiltration (HDF) may represent also a feasible alternative but has been poorly investigated. In this study, our aim was to evaluate the performance of on-line automated predilution heparin-free HDF as compared to conventional heparin-free HD with a heparin-coated membrane...
May 10, 2018: Hemodialysis International
https://www.readbyqxmd.com/read/29737362/-regional-citrate-anticoagulation-in-renal-replacement-therapy-in-the-intensive-care-station-recommendations-from-the-renal-section-of-the-dgiin-%C3%A3-giain-and-divi
#3
REVIEW
M Schmitz, M Joannidis, D Czock, S John, A Jörres, S J Klein, M Oppert, V Schwenger, J Kielstein, A Zarbock, D Kindgen-Milles, C Willam
BACKGROUND: Regional citrate anticoagulation (RCA) in continuous renal replacement therapy can effectively anticoagulate dialysis circuits without having adverse effects on systemic heparin application. In particular, in continuous renal replacement therapy RCA is well established and represents a safe procedure with longer filter lifetimes and fewer bleeding complications. OBJECTIVES: To provide guidance on the indications, advantages and disadvantages, and use of RCA, current recommendations from the renal section of the DGIIN (Deutschen Gesellschaft für Internistische Intensivmedizin und Notfallmedizin), ÖGIAIN (Österreichischen Gesellschaft für Internistische und Allgemeine Intensivmedizin und Notfallmedizin) and DIVI (Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin) are stated...
May 8, 2018: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/29597225/continuous-renal-replacement-therapy-quality-control-and-performance-measures
#4
Bo Shen, Jiarui Xu, Yimei Wang, Wuhua Jiang, Jie Teng, Xiaoqiang Ding
Continuous renal replacement therapy (CRRT) is one of the most predominant forms of renal replacement therapy (RRT) currently in use now, this therapy being the initial RRT modality in most critically ill patients. However, in general, the quality of CRRT is still suboptimal. The quality of CRRT is affected by many factors, including the optimal prescription and precision delivery, the CRRT providers' professional level, and the CRRT device used. Establishment of a comprehensive quality control system covering all the aspects and procedures of CRRT is essential...
2018: Contributions to Nephrology
https://www.readbyqxmd.com/read/29597222/clinical-complications-of-continuous-renal-replacement-therapy
#5
Florent Sigwalt, Axelle Bouteleux, François Dambricourt, Théo Asselborn, Florent Moriceau, Thomas Rimmelé
The various complications of continuous renal replacement therapy (CRRT) are mostly preventable. Hemodynamic disturbances are dominated by hypotension due to the modification of volume status, myocardial dysfunction, cardiac arrhythmia, or modification of systemic vascular resistances, which are correlated with body temperature changes. Metabolic complications remain at the forefront and have profoundly changed with the use of regional citrate anticoagulation (RCA). RCA may lead to two distinct situations: citrate overload and citrate accumulation, respectively, responsible for metabolic alkalosis and metabolic acidosis...
2018: Contributions to Nephrology
https://www.readbyqxmd.com/read/29597219/advances-in-machine-technology
#6
William R Clark, Gianluca Villa, Mauro Neri, Claudio Ronco
Continuous renal replacement therapy (CRRT) machines have evolved into devices specifically designed for critically ill over the past 40 years. In this chapter, a brief history of this evolution is first provided, with emphasis on the manner in which changes have been made to address the specific needs of the critically ill patient with acute kidney injury. Subsequently, specific examples of technology developments for CRRT machines are discussed, including the user interface, pumps, pressure monitoring, safety features, and anticoagulation capabilities...
2018: Contributions to Nephrology
https://www.readbyqxmd.com/read/29597215/evolution-of-vascular-access-and-anticoagulation
#7
Patrick M Honore, Herbert D Spapen
Continuous renal replacement therapy (CRRT) is an important and widely used adjuvant treatment in critically ill patients. However, any CRRT protocol can be adhered to only when the technique is correctly installed and functioning properly. Within this context, an appropriate vascular access and a safe and effective circuit anticoagulation method are key requisites. The right internal jugular (RIJ) vein is the preferred route for insertion with the tip of the catheter placed in the right atrium. Both femoral veins offer a valuable alternative access, but catheters must be longer to avoid recirculation and circuit blood flow is lower as compared with that of the RIJ approach...
2018: Contributions to Nephrology
https://www.readbyqxmd.com/read/29574675/warfarin-related-nephropathy-with-acute-kidney-injury-in-a-patient-with-immunoglobulin-a-nephropathy
#8
Hiroki Ishii, Keiji Hirai, Katsunori Yanai, Taisuke Kitano, Mitsutoshi Shindo, Haruhisa Miyazawa, Kiyonori Ito, Yuichiro Ueda, Yoshio Kaku, Taro Hoshino, Honami Mori, Susumu Ookawara, Yoshihiko Ueda, Yoshiyuki Morishita
A 55-year-old man with Marfan syndrome taking warfarin for anticoagulant therapy after aortic valve replacement developed acute kidney injury (serum creatinine level of 9.01 mg/dL) and gross macrohematuria. Renal biopsy showed red cell casts in the renal tubules, glomerular crescent formation in the glomeruli with immunoglobulin A deposition, and global sclerosis. Based on these findings, the patient was diagnosed with warfarin-related nephropathy with acute kidney injury characterized by immunoglobulin A nephropathy with crescents...
March 24, 2018: CEN Case Reports
https://www.readbyqxmd.com/read/29572101/impact-of-connecting-continuous-renal-replacement-therapy-to-the-extracorporeal-membrane-oxygenation-circuit
#9
Christian de Tymowski, Mathieu Desmard, Brice Lortat-Jacob, Quentin Pellenc, Soleiman Alkhoder, Arezki Alouache, Benedicte Fritz, Philippe Montravers, Augustin Pascal
Purpose Continuous veno-venous haemofiltration (CVVH) directly connected to extracorporeal membrane oxygenation (ECMO) may ensure better blood flow and allow prolonged circuit life. The objective of this study was to assess circuit life of CVVH connected to ECMO and to a dialysis catheter. Materials and Methods In this prospective observational study, patients receiving CVVH via ECMO were compared to time-matched patients receiving CVVH via a conventional dialysis catheter. CVVH circuit life and the safety and efficacy of the two CVVH procedures were analysed...
March 20, 2018: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/29538017/bivalirudin-dosing-requirements-in-adult-patients-on-extracorporeal-life-support-with-or-without-continuous-renal-replacement-therapy
#10
Elizabeth A Walker, A Joshua Roberts, Erin L Louie, William E Dager
Systemic anticoagulation with unfractionated heparin is standard of care for patients receiving extracorporeal life support (ECLS); however, an alternative anticoagulant may be necessary when challenges with heparin therapy arise. Evidence for alternative anticoagulation in ECLS patients is limited. This retrospective analysis evaluated the dosing and outcomes associated with bivalirudin use in 14 adult ECLS patients. Indications for bivalirudin included heparin-induced thrombocytopenia, heparin resistance, or persistent clotting or bleeding while on heparin...
March 13, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29456612/the-safety-of-regional-citrate-anticoagulation-in-renal-replacement-therapy
#11
Simon Hill, Elaine Creighton, Edward Walter
No abstract text is available yet for this article.
February 2018: Journal of the Intensive Care Society
https://www.readbyqxmd.com/read/29434171/association-between-intra-circuit-activated-clotting-time-and-incidence-of-bleeding-complications-during-continuous-renal-replacement-therapy-using-nafamostat-mesilate-a-retrospective-pilot-observational-study
#12
Yuji Miyatake, Shohei Makino, Kenta Kubota, Moritoki Egi, Satoshi Mizobuchi
It has been proposed that anticoagulant activity during continuous renal replacement therapy with nafamostat mesilate can be monitored by using intra-circuit activated clotting time. However, it is still unclear whether activated clotting time would be useful for this purpose. We conducted a retrospective study and included 76 patients who required continuous renal replacement therapy using nafamostat mesilate. We obtained information for pre- and post-filter activated clotting times and bleeding complications...
August 30, 2017: Kobe Journal of Medical Sciences
https://www.readbyqxmd.com/read/29426053/-renal-replacement-therapy-in-acute-kidney-injury-indication-and-implementation
#13
Mira Küllmar, Alexander Zarbock
Acute kidney injury (AKI) is a common complication in critically ill patients and is associated with a worse short- and long-term outcome. The KDIGO (Kidney Disease: Improving Global Outcomes) guidelines suggest to implement preventive strategies in high-risk patients. Definition and classification of acute kidney injury according to the KDIGO criteria are based on an increase in serum creatinine and/or a decrease in urinary output. Renal replacement therapy (RRT) is the only supportive measure in patients with severe AKI...
February 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29417731/super-high-flux-continuous-venovenous-hemodialysis-using-regional-citrate-anticoagulation-long-term-stability-of-middle-molecule-clearance
#14
Martin Siebeck, Thomas Dimski, Timo Brandenburger, Torsten Slowinski, Detlef Kindgen-Milles
Continuous renal replacement therapy is a standard treatment in critically ill patients with acute kidney injury. All CRRT techniques provide a high low-molecular weight clearance but even with hemofiltration, clearance of middle molecules is low. We investigated whether a new super high-flux hemofilter provides effective and sustained middle molecule clearance during citrate-anticoagulated continuous venovenous hemodialysis for up to 72 h. We included 14 critically ill patients with AKI-KDIGO-III in a prospective observational trial...
February 8, 2018: Therapeutic Apheresis and Dialysis
https://www.readbyqxmd.com/read/29402829/a-continuous-renal-replacement-therapy-protocol-on-the-updated-nikkiso-aquarius-platform-using-regional-citrate-as-first-line-anticoagulation-significantly-improves-filter-life-span-but-the-position-of-the-vascular-access-is-key
#15
https://www.readbyqxmd.com/read/29324487/renal-replacement-therapy-in-critically-ill-patients-who-when-why-and-how
#16
Melanie Meersch, Alexander Zarbock
PURPOSE OF REVIEW: The increasing incidence of acute kidney injury has the immediate effect of a growing need for renal replacement therapy (RRT). Shedding light on the questions of who, when, why, and how RRT should be performed is difficult to accomplish because of ambiguous study results, poor quality evidence, and low standardization. RECENT FINDINGS: Critically ill patients are exposed to multiple factors known to deteriorate kidney function. Especially severe fluid overload is strongly associated with worse outcome and may be considered as a trigger for initiating RRT...
April 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29304513/nonvitamin-k-antagonist-oral-anticoagulants-use-in-patients-with-atrial-fibrillation-and-bioprosthetic-heart-valves-prior-surgical-valve-repair-a-multicenter-clinical-practice-experience
#17
Vincenzo Russo, Emilio Attena, Carmine Mazzone, Francesca Esposito, Valentina Parisi, Ciro Bancone, Anna Rago, Gerardo Nigro, Raffaele Sangiuolo, Antonio D' Onofrio
This is an observational study to investigate the efficacy and safety of nonvitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients with bioprosthetic valves or prior surgical valve repair in clinical practice. A total of 122 patients (mean age: 74.1 ± 13.2; 54 females) with bioprosthetic heart valve or surgical valve repair and AF treated with NOACs were included in the analysis. The mean CHA2 DS2 -VASc (Congestive heart failure, Hypertension, Age >75 years, Diabetes mellitus, prior Stroke or transient ischemic attack, Vascular disease) and HAS-BLED (Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile INR [international normalized ratio], Elderly, Drugs or alcohol) score values were 3...
January 5, 2018: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/29248145/renal-replacement-therapy-and-anticoagulation
#18
REVIEW
Timo Brandenburger, Thomas Dimski, Torsten Slowinski, Detlef Kindgen-Milles
Today, up to 20% of all intensive care unit patients require renal replacement therapy (RRT), and continuous renal replacement therapies (CRRT) are the preferred technique. In CRRT, effective anticoagulation of the extracorporeal circuit is mandatory to prevent clotting of the circuit or filter and to maintain filter performance. At present, a variety of systemic and regional anticoagulation modes for CRRT are available. Worldwide, unfractionated heparin is the most widely used anticoagulant. All systemic techniques are associated with significant adverse effects...
September 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29248144/renal-replacement-therapy-for-aki-when-how-much-when-to-stop
#19
REVIEW
Stefano Romagnoli, William R Clark, Zaccaria Ricci, Claudio Ronco
Severe acute kidney injury (AKI) requiring renal replacement therapy (RRT) is a serious clinical disorder in the intensive care unit (ICU), occurring in a significant proportion of critically ill patients. However, many questions remain about the optimal administration of RRT with regard to several important considerations, including treatment dose, timing of treatment initiation and cessation, therapy mode, type of anticoagulation, and management of fluid overload. While Level 1 evidence exists for RRT dosing in AKI, all the studies contributing to this evidence base employed fixed-dose regimens throughout a patient's continuous RRT (CRRT) course, without regard for the possibility of individualizing treatment dose according to the clinical status of a given patient at a specific time...
September 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29198634/intraoperative-administration-of-4-factor-prothrombin-complex-concentrate-reduces-blood-requirements-in-cardiac-transplantation
#20
Gina H Sun, Visal Patel, Ingrid Moreno-Duarte, Farhad Zahedi, Eric Ursprung, Greg Couper, Fred Y Chen, Ian J Welsby, Raymond Comenzo, Grace Kao, Frederick C Cobey
OBJECTIVE: Assessing the efficacy of intraoperative 4-factor prothrombin complex concentrate (4F-PCC) use in blood product utilization, time to chest closure, intensive care unit (ICU) and hospital length of stay (LOS), thromboembolic complications, renal injury and mortality in left ventricular assist device (LVAD) patients on home anticoagulation therapy with warfarin, undergoing orthotopic heart transplantation (OHT). DESIGN: Retrospective analysis of OHT patients at Tufts Medical Center from May 2013 to October 2016...
February 2018: Journal of Cardiothoracic and Vascular Anesthesia
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