Arteriovenous haemofiltration: A new and simple method for treatment of over-hydrated patients resistant to diuretics

Krämer, P.; Wigger, W; Rieger, J.; Matthaei, D.; Scheler, F.

doi:10.1007/bf01477940

Cited by 548 publications

(135 citation statements)

References 3 publications

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“…The management of severe AKI requiring dialysis has evolved over the past several decades to include continuous RRT (CRRT), which was introduced to enable dialytic treatment of hemodynamically unstable patients for whom intermittent hemodialysis could be difficult to administer (2,3). CRRT may offer advantages over conventional intermittent hemodialysis, such as allowing the administration of large volumes of parenteral nutrition and other obligate fluids.…”

Section: Introductionmentioning

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: Introductionmentioning

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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“…MODS usually results from excessive releasing inflammatory cytokines and neurotransmitters, whether there are infectious or noninfectious causes. In 1977, continuous arteriovenous hemofiltration (CAVH) was reported by Kramer et al [1] as a continuous treatment for patients with acute renal failure. Since then, various other regimens for continuous renal replacement therapy, for example, continuous blood purification (CBP), have been developed.…”

Section: Discussionmentioning

confidence: 99%

“…It also can trigger a series of chaintype reaction, destroy homeostasis and organ function, and thus lead to multiple organ dysfunction syndrome (MODS). Continuous arteriovenous hemofiltration (CAVH) was reported by Kramer et al [1] in 1977 as a continuous treatment for patients with acute renal failure. Since then, the series of treatment models derived from CAVH have been named as a continuous renal replacement therapy, also known as continuous blood purification (CBP).…”

Section: Introductionmentioning

confidence: 99%

Application of bedside continuous blood purification in patients with multiple organ dysfunction syndromes

Liu¹,

Zhang²,

Zhang³

et al. 2012

World Journal of Emergency Medicine

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“…Continuous arterio-venous hemofiltration (CAVH) was a simple method for blood purification and body fluid control originally described by Kramer et al in adults in 1977 [5]. In this classic system, a small hemofilter is connected to an artery and a vein, and a simple arterio-venous hydrostatic pressure gradient generated by the heart moves the blood through the circuit, producing slow continuous UF.…”

Section: The Birth Of Crrt In Infants and Childrenmentioning

confidence: 99%

CA.R.PE.DI.E.M. (Cardio–Renal Pediatric Dialysis Emergency Machine): evolution of continuous renal replacement therapies in infants. A personal journey

2012

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Pedriatric acute kidney injury (AKI) is a welldescribed clinical syndrome that is characterized by a reduction of both the urine output and glomerular filtration rate. AKI in critically ill children is typically associated with multiple organ dysfunction. A dramatic increase in the incidence of AKI in pediatric intensive care units has been observed in the last 10 years. Unfortunately, the absence of sufficiently effective preventive and therapeutic measures at the present time has limited significant improvements in AKI care. Morality in patients with severe AKI remains unacceptably high (>50 %), with renal replacement therapy (RRT) remaining the most effective form of support for these patients. Despite technological advances during the last 10 years which have resulted in the development of the so-called "third-generation dialysis machines" that are characterized by the highest level of safety and accuracy, a truly pedriatric RRT system has never been developed. Consequently, dialysis/hemofiltration in critically ill children is currently performed by adapting adult systems to the much smaller pediatric patients. In particular, research in this field should focus on children weighing less than 10 kg for whom the delivery of RRT is a clinical and technological challenge. We describe here the evolution of pediatric RRT during the last 30 years and report in detail on the CARPE-DIEM project, which has recently been established to finally provide neonates and infants with a reliable dialysis machine that is specifically designed for this age group.

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Arteriovenous haemofiltration: A new and simple method for treatment of over-hydrated patients resistant to diuretics

Cited by 548 publications

References 3 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

Application of bedside continuous blood purification in patients with multiple organ dysfunction syndromes

CA.R.PE.DI.E.M. (Cardio–Renal Pediatric Dialysis Emergency Machine): evolution of continuous renal replacement therapies in infants. A personal journey

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