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dialysis filter clotting

Jennifer O Kwon, Robert MacLaren
STUDY OBJECTIVE: To evaluate fresh-frozen plasma (FFP), four-factor prothrombin complex concentrates (PCCs), and recombinant factor VIIa (rFVIIa) for lowering international normalized ratio (INR) and facilitating procedures in critically ill patients with hepatic impairment. DESIGN: Retrospective cohort study. SETTING: Intensive care units at a large university-affiliated teaching hospital. PATIENTS: Forty-five adults with hepatic impairment who were admitted between September 1, 2011, and December 31, 2015, and had an admission INR of 1...
October 2016: Pharmacotherapy
Heleen M Oudemans-van Straaten, Marlies Ostermann
Citrate has been recommended as the first-line anticoagulant for continuous renal replacement therapy (CRRT) in critically ill patients. Compared with heparin, citrate anticoagulation is safer and more efficacious. Citrate inhibits the coagulation cascade by lowering the ionized calcium (iCa) concentration in the filter. Monitoring of systemic iCa concentrations is inherent to the protocol, and monitoring of postfilter iCa is recommended to adjust citrate flow and optimize anticoagulation. While systemic iCa targets are in the physiological range, postfilter iCa concentrations are targeted between 0...
2015: Critical Care: the Official Journal of the Critical Care Forum
Saskia Wand, Sonia Schneider, Patrick Meybohm, Kai Zacharowski, Christian Friedrich Weber
BACKGROUND: Continuous renal replacement therapy (CRRT) is a standard therapy in critically ill patients suffering from acute kidney injury (AKI). Extracorporeal circulation and exposure to foreign surfaces during CRRT may induce disturbances in hemostasis, particularly in platelet function. The present study described the hemostatic changes associated with CRRT and aimed to identify the independent predictors of premature clotting of the circuit. METHODS: In a prospective cohort mono-center study, patients were assessed for eligibility if they were i) diagnosed with AKI and ii) assigned to receive CRRT for the first time...
2015: Clinical Laboratory
Bianca Ballarin Albino, André Luis Balbi, Juliana Maria Gera Abrão, Daniela Ponce
Prolonged intermittent renal replacement therapy (PIRRT) has emerged as an alternative to continuous renal replacement therapy in the management of acute kidney injury (AKI) patients. This trial aimed to compare the dialysis complications occurring during different durations of PIRRT sessions in critically ill AKI patients. We included patients older than 18 years with AKI associated with sepsis admitted to the intensive care unit and using noradrenaline doses ranging from 0.3 to 0.7 µg/kg/min. Patients were divided into two groups randomly: in G1, 6-h sessions were performed, and in G2, 10-h sessions were performed...
May 2015: Artificial Organs
Giovanni M Frascà, Sibilla Sagripanti, Mario D'Arezzo, Simonetta Oliva, Angelo Francioso, Giovanni Mosconi, Loretta Zambianchi, Franco Sopranzi, Rolando Boggi, Laura Fattori, Angelo Rigotti, Laura Maldini, Andrea Gattiani, Goffredo Del Rosso, Antonio Federico, Lidia Da Lio, Luigi Ferrante
The aim of this multicenter, prospective study was to explore the possibility of carrying out routine sessions of post-dilution hemodiafiltration with a polyacrylonitrile membrane grafted with heparin (HeprAN) and reduced anticoagulation. Forty-four patients from eight centers were included in the study and treated by means of post-dilution on-line hemodiafiltration with automatic control of TMP, according to three different modalities tested consecutively: phase 1, polyethersulfone filter primed with heparinized saline and anticoagulated with continuous infusion of unfractionated heparin 1000/h; phase 2, HeprAN membrane filter primed with saline without heparin...
April 2015: Therapeutic Apheresis and Dialysis
Bianca Ballarin Albino, André Luis Balbi, Daniela Ponce
This trial aimed to compare the dialysis complications occurring during different durations of extended daily dialysis (EDD) sessions in critically ill AKI patients. We included patients older than 18 years with AKI associated with sepsis admitted to the intensive care unit and using noradrenaline dose ranging from 0.3 to 0.7 μg/kg/min. Patients were divided into two groups randomly: in G1, 6 h sessions were performed and, in G2, 10 h sessions were performed. Seventy-five patients were treated with 195 EDD sessions for 18 consecutive months...
2014: BioMed Research International
Sian Robinson, Aleksander Zincuk, Ulla Lei Larsen, Claus Ekstrøm, Palle Toft
BACKGROUND: Previous pharmacokinetic trials suggested that 40 mg subcutaneous enoxaparin once daily provided inadequate thromboprophylaxis for intensive care unit patients. Critically ill patients with acute kidney injury are at increased risk of venous thromboembolism and yet are often excluded from these trials. We hypothesized that for critically ill patients with acute kidney injury receiving continuous renal replacement therapy, a dose of 1 mg/kg enoxaparin subcutaneously once daily would improve thromboprophylaxis without increasing the risk of bleeding...
2014: Trials
Song C Ong, Keith M Wille, Rajesh Speer, Ashita J Tolwani
INTRODUCTION: Regional citrate anticoagulation (RCA) is used as an anticoagulant for continuous renal replacement therapy (CRRT). A systemic calcium (Ca2+) infusion is required to replace Ca2+ lost in the effluent. The shortage of intravenous Ca2+ in the United States has limited RCA use. We describe a continuous veno-venous hemofiltration (CVVH) protocol with RCA using 2.2% anticoagulant citrate dextrose formula-A (ACD-A) and a commercial dialysate containing Ca2+ 1.5 mmol/l (N × Stage) as post-filter replacement fluid (RF), without need for Ca2+ infusion...
June 2014: International Journal of Artificial Organs
Dmytro Khadzhynov, Torsten Slowinski, Ina Lieker, Hans-H Neumayer, Harm Peters
BACKGROUND: Regional citrate anticoagulation (RCA) is increasingly used in patients requiring continuous renal replacement therapy (CRRT). This study evaluated a new RCA protocol based on the Prismaflex® dialysis device and an isotonic citrate solution (prismocitrate) for pre-dilution continous veno-venous hemodiafiltration. METHODS: The Prismaflex®/Prismocitrate-based protocol involved an AN69ST® membrane (Prisma Flex ST100), a blood flow of 120 mL/min, 1.8 L/h Prismocitrate (10 mmol/L citrate/2 mmol/L citric acid) substitution fluid in pre-dilution mode, and 0...
May 2014: Clinical Nephrology
Rolando Claure-Del Granado, Etienne Macedo, Sharon Soroko, YeonWon Kim, Glenn M Chertow, Jonathan Himmelfarb, T Alp Ikizler, Emil P Paganini, Ravindra L Mehta
Delivered dialysis dose by continuous renal replacement therapies (CRRT) depends on circuit efficacy, which is influenced in part by the anticoagulation strategy. We evaluated the association of anticoagulation strategy used on solute clearance efficacy, circuit longevity, bleeding complications, and mortality. We analyzed data from 1740 sessions 24 h in length among 244 critically ill patients, with at least 48 h on CRRT. Regional citrate, heparin, or saline flushes was variably used to prevent or attenuate filter clotting...
July 2014: Hemodialysis International
Daniela Ponce, Juliana Maria Gera Abrão, Bianca Ballarin Albino, André Luis Balbi
UNLABELLED: Intermittent hemodialysis (IHD) and continuous renal replacement therapies (CRRT) are used as Acute Kidney Injury (AKI) therapy and have certain advantages and disadvantages. Extended daily dialysis (EDD) has emerged as an alternative to CRRT in the management of hemodynamically unstable AKI patients, mainly in developed countries. OBJECTIVES: We hypothesized that EDD is a safe option for AKI treatment and aimed to describe metabolic and fluid control of AKI patients undergoing EDD and identify complications and risk factors associated with death...
2013: PloS One
Song-tao Yang, Hong Wu, Xiao-yun Gao, Jun Hu, Yue-fei Xiao
OBJECTIVE: To assess the blood coagulation function and investigate the appropriate dose of unfractionated heparin by thromboelastograph in maintenance hemodialysis (MHD) patients. METHODS: Thirty MHD patients were enrolled in this study and divided into two groups. The total dose of unfractionated heparin was below 80 u/kg in the low-dose group (LH, n=16), while it exceeded 80 u/kg in the high-dose group (HH, n=14). Blood routine tests and conventional coagulation examinations were measured before hemodialysis...
August 18, 2013: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
Robert Kalb, Rainer Kram, Stanislao Morgera, Torsten Slowinski, Detlef Kindgen-Milles
Acute kidney injury requiring renal replacement therapy occurs in up to 10% of all intensive care unit patients. Those who are hemodynamically unstable are often treated with continuous renal replacement therapy requiring continuous anticoagulation of the extracorporeal circuit. This is usually achieved by infusion of unfractionated heparin, which subsequently increases the risk of bleeding. To avoid systemic anticoagulation for continuous renal replacement therapy, regional anticoagulation with citrate has been introduced...
April 2013: Therapeutic Apheresis and Dialysis
Mohamed Khaled El Hatw, Fatina Fadel, Ramzy El Baroudy
In rapid accelerated hemodialysis (R-AHD), blood partially recirculates from the venous (outflow) to the arterial (inflow) line through a recirculation line (R) to selectively increase the filter blood flow rate (BFR). R-AHD PR uses two blood pump segments at the patient segment of the arterial line and at (R). To determine the effectiveness of R-AHD with regard to increasing anticoagulation and dialysis efficiency, we studied ten children with end-stage renal disease in two stages: stage 1 with 10 routine heparin R-AHD, then 10 half-dose heparin R-AHD, then 145 routine heparin R-AHD sessions for 1 month and then routine heparin double needle hemodialysis (DNHD) for one month (control)...
January 2013: Saudi Journal of Kidney Diseases and Transplantation
Bernd G Stegmayr, Per Jonsson, Dana Mahmood
BACKGROUND: The blood membrane interaction induced during hemodialysis (HD) activates the coagulation system. To prevent clotting and to maintain dialyzer patency, an anticoagulant such as tinzaparin is used. To increase patency of the dialyzers and to reduce the risk of bleeding related to anticoagulation, citrate-containing dialysate has been introduced in Europe. 
 PURPOSE: The aim of this randomized, cross-over study was to investigate if citrate-containing dialysate was safe and efficient enough as the sole anticoagulation agent in chronic HD patients...
January 2013: International Journal of Artificial Organs
Achim Jörres
The optimal choice of modality for acute renal replacement therapy is unclear at present. Diffusive therapy (hemodialysis) removes small solutes mainly, whereas convective therapies (hemofiltration and hemodiafiltration) may also eliminate larger molecules such as myoglobin or cytokines. Conversely, convective therapies might predispose patients to filter clotting and thus increased costs. A systematic review and meta-analysis of clinical trials could not find evidence for clinical benefits of either modality...
2012: Critical Care: the Official Journal of the Critical Care Forum
Oliver Dorsch, Detlef H Krieter, Horst-Dieter Lemke, Stefan Fischer, Nima Melzer, Christian Sieder, Peter Bramlage, Job Harenberg
BACKGROUND: Adequate anticoagulation is prerequisite for effective hemodialysis to prevent clotting in the extracorporeal circuit. We aimed providing first data on the efficacy and safety of the low-molecular-weight heparin certoparin in this setting. METHODS: Multicenter, open-label, 8-week trial. Patients received a single dose of 3,000 IU certoparin i.v. with additional titration steps of 600 IU and/or continuous infusion if necessary. RESULTS: 120 patients were screened, 109 enrolled (median age 71; range 26-90 years) and 106 available for efficacy analyses...
2012: BMC Nephrology
Sigrid Beitland, Kjetil Sunde, Harald Moen, Ingrid Os
Introduction. Acute kidney injury (AKI) necessitating continuous renal replacement therapy (CRRT) is a severe complication in trauma patients (TP). We wanted to assess daily duration of CRRT and its impact on uremic control in TP. Material and Methods. We retrospectively reviewed adult TP, with or without rhabdomyolysis, with AKI undergoing CRRT. Data on daily CRRT duration and causes for temporary stops were collected from the first five CRRT days. Uremic control was assessed by daily changes in serum urea (Δurea) and creatinine (Δcreatinine) concentrations...
2012: Critical Care Research and Practice
Marco Pozzato
Anticoagulation of the extracorporeal circuit, necessary for the correct management of renal replacement treatment in acute renal failure, is essential. There is a high risk of bleeding secondary to the presence of complex platelet and coagulation abnormalities, the effect of uremia, recent surgery or a state of sepsis. This requires careful evaluation of the type of anticoagulation to be used to prevent blood clotting of the circuit, maintain filter efficiency, and minimize the risk of bleeding. In critically ill patients with no risk of bleeding, heparin is still the anticoagulant treatment of choice...
January 2012: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Andreas Bacher
Acute liver failure is a very complex type of disease with a mortality of up to 90%, leading to numerous severe disturbances of the whole organism. Bleeding because of absent synthesis of various coagulation factors and disseminated intravascular coagulation, acute kidney failure, circulatory failure with vasopressor dependence, respiratory failure with adult respiratory distress syndrome, neurological failure up to coma because of hepatic encephalopathy, and a very high risk of infection and sepsis frequently result from the initial state of isolated liver failure...
September 2011: Liver International: Official Journal of the International Association for the Study of the Liver
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