Accelerated Venovenous Hemofiltration: Early Technical and Clinical Experience

Gashti, Casey N.; Salcedo, Suzana P.; Robinson, V B; Rodby, Roger A.

doi:10.1053/j.ajkd.2008.01.012

Cited by 36 publications

(38 citation statements)

References 22 publications

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“…Supplementation of dialysate and replacement solutions with phosphate should also be considered (25)(26)(27). Alternative CRRT strategies, such as accelerated veno-venous hemofiltration (28), which may lead to less phosphate removal, should be tested and compared with CRRT.…”

Section: Discussionmentioning

confidence: 99%

Reductions in Red Blood Cell 2,3-Diphosphoglycerate Concentration during Continuous Renal Replacment Therapy

Brugnara

Betensky

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Hypophosphatemia is a frequent complication during continuous renal replacement therapy (CRRT), a dialytic technique used to treat AKI in critically ill patients. This study sought to confirm that phosphate depletion during CRRT may decrease red blood cell (RBC) concentration of 2,3-diphosphoglycerate (2,3-DPG), a crucial allosteric effector of hemoglobin's (Hgb's) affinity for oxygen, thereby leading to impaired oxygen delivery to peripheral tissues.Design, setting, participants, & measurements Phosphate mass balance studies were performed in 20 patients with severe AKI through collection of CRRT effluent. RBC concentrations of 2,3-DPG, venous blood gas pH, and oxygen partial pressure required for 50% hemoglobin saturation (P50) were measured at CRRT initiation and days 2, 4, and 7. Similar measurements were obtained on days 0 and 2 in a reference group of 10 postsurgical patients, most of whom did not have AKI. Associations of 2,3-DPG with laboratory parameters and clinical outcomes were examined using mixed-effects and Cox regression models.Results Mean 2,3-DPG levels decreased from a mean (6SD) of 13.463.4 mmol/g Hgb to 11.063.1 mmol/g Hgb after 2 days of CRRT (P,0.001). Mean hemoglobin saturation P50 levels decreased from 29.764.4 mmHg to 26.764.0 mmHg (P,0.001). No significant change was seen in the reference group. 2,3-DPG levels after 2 days of CRRT were not significantly lower than those in the reference group on day 2. Among patients receiving CRRT, 2,3-DPG decreased by 0.53 mmol/g Hgb per 1 g phosphate removed (95% confidence interval 0.38 to 0.68 mmol/g Hgb; P,0.001). Greater reductions in 2,3-DPG were associated with higher risk for death (hazard ratio, 1.43; 95% confidence interval, 1.09 to 1.88; P=0.01).Conclusions CRRT-induced phosphate depletion is associated with measurable reductions in RBC 2,3-DPG concentration and a shift in the O 2 :Hgb affinity curve even in the absence of overt hypophosphatemia. 2,3-DPG reductions may be associated with higher risk for in-hospital death and represent a potentially avoidable complication of CRRT.

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Section: Discussionmentioning

confidence: 99%

Reductions in Red Blood Cell 2,3-Diphosphoglycerate Concentration during Continuous Renal Replacment Therapy

Brugnara

Betensky

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…Body weight was derived from a large PIRRT study [4] and pharmacokinetic data from published ciprofloxacin and levofloxacin pharmacokinetic studies in critically ill patients receiving RRT [29][30][31][32][33][34][35][36]. In order to avoid spurious simulations, limits were obtained from those previous studies and were set for all input parameters.…”

Section: Pharmacokinetic Model Developmentmentioning

confidence: 99%

“…In order to avoid spurious simulations, limits were obtained from those previous studies and were set for all input parameters. Body weight lower limits were set at ≥40 kg assuming that the virtual patients are adults [4]. The ranges of volume of distribution (V d ) and non-renal clearance values (CL NR ) were extracted from the relevant ciprofloxacin and levofloxacin pharmacokinetic studies [29][30][31][32][33][34][35][36].…”

Section: Pharmacokinetic Model Developmentmentioning

confidence: 99%

“…The typical duration of PIRRT is 6-12 h, providing the benefits of better patient mobility and less cost compared to CRRT, but a longer treatment period with slower flow rates which allows for better tolerated fluid removal than IHD [1][2][3][4][5][6]. With these unique qualities and similar patient outcomes compared to conventional RRT, more clinicians are considering PIRRT as a viable treatment option for acute kidney injury in critically ill patients [1][2][3][4][5][6][7]. However, very few antibiotic pharmacokinetic studies have been conducted in patients receiving PIRRT, prompting one set of authors to opine that PIRRT is a rational RRT that does not allow for rational drug dosing [8].…”

Section: Introductionmentioning

confidence: 99%

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In silico trials using Monte Carlo simulation to evaluate ciprofloxacin and levofloxacin dosing in critically ill patients receiving prolonged intermittent renal replacement therapy

et al. 2016

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Background: Prolonged intermittent renal replacement therapy (PIRRT) is a growing option to treat acute kidney injury in critically ill patients, but absent pharmacokinetic data challenge optimal drug dosing. Inappropriate antibiotic dosing can cause widespread bacterial resistance and decreased antibiotic utility. The purpose of this study was to evaluate probability of target attainment (PTA) of various ciprofloxacin and levofloxacin regimens in critically ill patients receiving PIRRT, utilizing Monte Carlo simulation (MCS).

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“…Termed accelerated venovenous hemofiltration, this modality retains many of the feasibility advantages of SLED, but dedicated commercial solutions were still required. A retrospective case series demonstrated adequate solute removal, acceptable hemodynamic tolerability and the ability to avoid systemic anticoagulation [33]. …”

Section: Rrt Modality Choicementioning

confidence: 99%

Renal Replacement Therapy for Acute Kidney Injury

2009

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The treatment of established acute kidney injury (AKI) is largely supportive in nature. Renal replacement therapy remains the cornerstone of management for the minority of patients who have severe AKI. Optimization of renal replacement therapy may modulate the high mortality associated with AKI. Recent trials indicated that continuous renal replacement therapy does not confer a survival advantage as compared to intermittent hemodialysis. Furthermore, there is no evidence to support a more intensive strategy of renal replacement therapy in the setting of AKI. There is comparatively limited data regarding the ideal timing of renal replacement therapy initiation and the preferred mode of solute clearance.

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Accelerated Venovenous Hemofiltration: Early Technical and Clinical Experience

Cited by 36 publications

References 22 publications

Reductions in Red Blood Cell 2,3-Diphosphoglycerate Concentration during Continuous Renal Replacment Therapy

Reductions in Red Blood Cell 2,3-Diphosphoglycerate Concentration during Continuous Renal Replacment Therapy

In silico trials using Monte Carlo simulation to evaluate ciprofloxacin and levofloxacin dosing in critically ill patients receiving prolonged intermittent renal replacement therapy

Renal Replacement Therapy for Acute Kidney Injury

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