Bicarbonate- versus lactate-buffered solutions for acute continuous haemodiafiltration or haemofiltration

Tian, Jin Hui; Ma, Bin; Yang, Kehu; Liu, Yali; Tan, Jiying; Liu, Tian Xi

doi:10.1002/14651858.cd006819.pub2

Cited by 10 publications

(8 citation statements)

References 46 publications

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“…Forty-seven studies underwent full text review. Of these, 28 were excluded because there was no comparator group, five were dialysate buffer comparisons, two involved dialyzer membranes, one was unrelated to the study topic, one was a modality comparison, and one was a systematic review of bicarbonate versus lactate-buffered solutions for AKI treated with RRT [ 17 ].…”

Section: Resultsmentioning

confidence: 99%

Interventions to prevent hemodynamic instability during renal replacement therapy in critically ill patients: a systematic review

et al. 2018

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BackgroundHemodynamic instability related to renal replacement therapy (HIRRT) may increase the risk of death and limit renal recovery. Studies in end-stage renal disease populations on maintenance hemodialysis suggest that some renal replacement therapy (RRT)-related interventions (e.g., cool dialysate) may reduce the occurrence of HIRRT, but less is known about interventions to prevent HIRRT in critically ill patients receiving RRT for acute kidney injury (AKI). We sought to evaluate the effectiveness of RRT-related interventions for reducing HIRRT in such patients across RRT modalities.MethodsA systematic review of publications was undertaken using MEDLINE, MEDLINE in Process, EMBASE, and Cochrane’s Central Registry for Randomized Controlled Trials (RCTs). Studies that assessed any intervention’s effect on HIRRT (the primary outcome) in critically ill patients with AKI were included. HIRRT was variably defined according to each study’s definition. Two reviewers independently screened abstracts, identified articles for inclusion, extracted data, and evaluated study quality using validated assessment tools.ResultsFive RCTs and four observational studies were included (n = 9; 623 patients in total). Studies were small, and the quality was mostly low. Interventions included dialysate sodium modeling (n = 3), ultrafiltration profiling (n = 2), blood volume (n = 2) and temperature control (n = 3), duration of RRT (n = 1), and slow blood flow rate at initiation (n = 1). Some studies applied more than one strategy simultaneously (n = 5). Interventions shown to reduce HIRRT from three studies (two RCTs and one observational study) included higher dialysate sodium concentration, lower dialysate temperature, variable ultrafiltration rates, or a combination of strategies. Interventions not found to have an effect included blood volume and temperature control, extended duration of intermittent RRT, and slower blood flow rates during continuous RRT initiation. How HIRRT was defined and its frequency of occurrence varied widely across studies, including those involving the same RRT modality. Pooled analysis was not possible due to study heterogeneity.ConclusionsSmall clinical studies suggest that higher dialysate sodium, lower temperature, individualized ultrafiltration rates, or a combination of these strategies may reduce the risk of HIRRT. Overall, for all RRT modalities, there is a paucity of high-quality data regarding interventions to reduce the occurrence of HIRRT in critically ill patients.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-1965-5) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Interventions to prevent hemodynamic instability during renal replacement therapy in critically ill patients: a systematic review

et al. 2018

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“…If this process is impaired by liver dysfunction in critical illness, acidosis by way of lactate accumulation can result [71]. A Cochrane systematic review of four studies comparing bicarbonate-buffered solutions with lactate-buffered solutions for AKI concluded that, although there was no significant mortality difference, bicarbonate-based dialysate results in less HIRRT and lower serum lactate levels [72]. As a result, bicarbonate-based buffers are standard in current practice [73].…”

Section: Rrt-related Mechanisms For Hirrtmentioning

confidence: 99%

Mechanisms for hemodynamic instability related to renal replacement therapy: a narrative review

et al. 2019

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Hemodynamic instability related to renal replacement therapy (HIRRT) is a frequent complication of all renal replacement therapy (RRT) modalities commonly used in the intensive care unit. HIRRT is associated with increased mortality and may impair kidney recovery. Our current understanding of the physiologic basis for HIRRT comes primarily from studies of end-stage kidney disease patients on maintenance hemodialysis in whom HIRRT is referred to as 'intradialytic hypotension'. Nonetheless, there are many studies that provide additional insights into the underlying mechanisms for HIRRT specifically in critically ill patients. In particular, recent evidence challenges the notion that HIRRT is almost entirely related to excessive ultrafiltration. Although excessive ultrafiltration is a key mechanism, multiple other RRT-related mechanisms may precipitate HIRRT and this could have implications for how HIRRT should be managed (e.g., the appropriate response might not always be to reduce ultrafiltration, particularly in the context of significant fluid overload). This review briefly summarizes the incidence and adverse effects of HIRRT and reviews what is currently known regarding the mechanisms underpinning it. This includes consideration of the evidence that exists for various RRT-related interventions to prevent or limit HIRRT. An enhanced understanding of the mechanisms that underlie HIRRT, beyond just excessive ultrafiltration, may lead to more effective RRT-related interventions to mitigate its occurrence and consequences.

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“…In 2015, a Cochrane systematic review assessed the composition of dialysate and replacement solutions and compared bicarbonate-buffered solutions versus lactate-buffered solutions for CRRT. 96 Analysis of 4 clinical trials that included 171 patients revealed no significant differences in mortality and acid-base or electrolyte parameters, except for higher serum lactate levels in the lactate group. Only 1 study reported fewer cardiovascular events and fewer hypotensive events in the bicarbonate group, 71 whereas a different study found a higher mean arterial pressure using bicarbonate.…”

Section: Methodsmentioning

confidence: 95%

Renal Support for Acute Kidney Injury in the Developing World

Annigeri

Ostermann

Tolwani

et al. 2017

Kidney International Reports

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There is wide variation in the management of acute kidney injury (AKI) and the practice of renal replacement therapy (RRT) around the world. Clinicians in developing countries face additional challenges due to limited resources, reduced availability of trained staff and equipment, cultural and socioeconomic aspects, and administrative and governmental barriers. In this article, we report the consensus recommendations from the 18th Acute Dialysis Quality Initiative conference in Hyderabad, India. We provide the minimal requirements for provision of acute RRT in developing countries, including patient selection, choice of RRT modality and monitoring, transition, and termination of acute RRT. We also discuss areas of uncertainty and propose themes for future research. These recommendations can serve as a foundation for clinicians to implement renal support for AKI in low resource settings.

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Bicarbonate- versus lactate-buffered solutions for acute continuous haemodiafiltration or haemofiltration

Cited by 10 publications

References 46 publications

Interventions to prevent hemodynamic instability during renal replacement therapy in critically ill patients: a systematic review

Interventions to prevent hemodynamic instability during renal replacement therapy in critically ill patients: a systematic review

Mechanisms for hemodynamic instability related to renal replacement therapy: a narrative review

Renal Support for Acute Kidney Injury in the Developing World

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