Continuous Renal Replacement Therapies: A Brief Primer for the Neurointensivist

Patel, Pritesh; Nandwani, Veena; McCarthy, Paul; Conrad, Steven A.; Scott, L.

doi:10.1007/s12028-010-9386-6

Cited by 19 publications

(11 citation statements)

References 64 publications

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“…Traditionally, HF has been used in patients with acute renal failure associated with several conditions, including heart failure, volume overload, chronic liver failure and brain swelling [55]. Non-renal indications include systemic inflammatory response, hyperkalemia, sepsis and septic shock, multi-organ failure and adult respiratory distress syndrome [55]. …”

Section: Extracorpeal Methods Of Blood Glutamate Reductionmentioning

confidence: 99%

Extracorporeal methods of blood glutamate scavenging: a novel therapeutic modality

Zhumadilov

Boyko

Gruenbaum

et al. 2015

Expert Review of Neurotherapeutics

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Pathologically elevated glutamate concentrations in the brain's extracellular fluid are associated with several acute and chronic brain insults. Studies have demonstrated that by decreasing the concentration of glutamate in the blood, thereby increasing the concentration gradient between the brain and the blood, the rate of brain-to-blood glutamate efflux can be increased. Blood glutamate scavengers, pyruvate and oxaloacetate have shown great promise in providing neuroprotection in many animal models of acute brain insults. However, glutamate scavengers’ potential systemic toxicity, side effects and pharmacokinetic properties may limit their use in clinical practice. In contrast, extracorporeal methods of blood glutamate reduction, in which glutamate is filtered from the blood and eliminated, may be an advantageous adjunct in treating acute brain insults. Here, we review the current evidence for the glutamate-lowering effects of hemodialysis, peritoneal dialysis and hemofiltration. The evidence reviewed here highlights the need for clinical trials.

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Section: Extracorpeal Methods Of Blood Glutamate Reductionmentioning

confidence: 99%

Extracorporeal methods of blood glutamate scavenging: a novel therapeutic modality

Zhumadilov

Boyko

Gruenbaum

et al. 2015

Expert Review of Neurotherapeutics

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“…There was a similar degree of P bt O 2 responsiveness to CPP compared to while on HD ( figure 1D). In addition, ORx was [2][3][4][5] Though the exact mechanism remains unclear, several theories, including the reverse urea effect, increase in idiogenic osmolar products, or a paradoxical intracellular acidosis, exist. [2][3][4] Our case shows a close relationship between initiation of HD and surges of ICP together with a decline in P bt O 2 .…”

Section: Oystermentioning

confidence: 99%

Pearls & Oy-sters: The effects of renal replacement therapy on cerebral autoregulation

Choi

Gilmore

et al. 2012

Neurology

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PEARLS• Hemodialysis (HD) has been associated with increases in intracranial pressure (ICP). Osmotic shifts occurring during HD are thought to be associated with the development of this phenomenon.• In comatose patients with acute brain injury, an elevation of ICP during HD may be associated with worse cerebral autoregulation. Continuous veno-venous hemofiltration (CVVH) may be a safer alternative in these patients. OYSTER• HD may increase ICP; therefore, caution should be exercised when HD is needed in patients with acute brain injury.CASE REPORT A 59-year-old man with hypertension, type 1 diabetes, and end-stage renal disease on HD presented after head trauma from a fall while walking. Initial neurologic examination showed agitated confusion (E4 M5 V5) and a noncontrast head CT showed a nondepressed linear skull fracture in the right temporal bone with a small amount of subarachnoid hemorrhage in the left superior frontal convexity. On arrival to the neurointensive care unit (NICU), his mental status deteriorated (E1 M4 VT) and a follow-up noncontrast head CT revealed a new intracerebral hemorrhage (ICH) in the left temporal lobe (4.3 cm ϫ 2.2 cm ϫ 3.5 cm) with surrounding edema ( figure 1A). The patient's family opted for maximal medical management. Multimodality monitoring (MMM) including an intracranial pressure (ICP) monitor (Camino, Integra Lifesciences) and a brain oxygen monitor (Licox, Integra Lifesciences) was placed in the left frontal lobe, close to the perihematomal region. HD was performed every other day via a pre-existing left groin arteriovenous fistula with a negative goal fluid balance of 2 L per each 3.5-hour session. Initially, MMM demonstrated a mildly elevated ICP (mean 18.9 Ϯ 7.4 mm Hg) over a wide range of mean arterial pressures (MAPs) (60 -120 mm Hg) and ICP increase was not directly proportional to MAP changes, suggesting intact autoregulation. Pressure reactivity index (PRx), a Pearson moving correlation coefficient between MAP and mean ICP, which is accepted as a surrogate for autoregulation status, was also stable at 0.18 Ϯ 0.05 (mean Ϯ SD), implying intact pressure autoregulation. Partial brain oxygen tension (P bt O 2 ) was directly proportional to the cerebral perfusion pressure (CPP) up to 80 mm Hg. Oxygen reactivity index, a moving correlation coefficient between P bt O 2 and CPP, was 0.19 Ϯ 0.11. The mean P bt O 2 value was 43.1 Ϯ 11.2 mm Hg. Over the initial 2 weeks, the ICP trended up, requiring hyperosmotic agents to maintain an ICP below 20 mm Hg. Glasgow Coma Scale score deteriorated to E1, M2, VT. Follow-up brain CT scan showed increased perihematomal vasogenic edema with aggravated midline shift (figure 2). On hospital day 16, while receiving his regularly scheduled HD, the ICP surged up to 38 mm Hg just after initiating HD and remained elevated during the entire session. ICP was directly dependent on MAP, suggesting a loss of autoregulation ( figure 1B). Additionally, PRx values were elevated more than 0.2, which also suggested autoregulatory failure (figure 1C). Mea...

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“…Such patients show mortality rates of 50 %-60 % (Ricci et al, 2006;Palmer, 2001). Critically ill patients with AKI usually receive continuous renal replacement therapy (CRRT) treatments (Patel et al, 2010;Patschan and Müller, 2015;Ricci et al, 2006;Tumlin et al, 2008). The major difference between CRRT and the regular intermittent dialysis applied to chronic kidney diseases is the duration of the treatment and the rate at which water and waste products are removed from the extracorporeal circuit via diffusion across the semipermeable membrane of the dialyzer (Patel et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

In-line monitoring of electrolytes and urea during continuous renal replacement therapy

Berger¹,

Sehlmeyer²,

Sellering³

et al. 2020

J. Sens. Sens. Syst.

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Abstract. The individualization of dialysis treatment using a customized dialysate composition usually requires a continuous measurement of electrolytes and urea in blood. The current practices are spot measurements of blood samples either with blood gas analyzers or in the laboratory, involving considerable personnel effort. Furthermore, the measured values are time delayed and not available in a continuous fashion. In this paper we investigate an in-line concept for continuous monitoring of important blood parameters such as sodium, potassium, calcium and urea concentrations in blood serum using ion-selective electrodes. This concept is evaluated in a preclinical study with human packed red blood cells as a test medium over a period of 7 h. It has been shown that the electrolytes can be well monitored. In addition, we present first measurements with ion-sensitive field-effect transistors in a miniaturized sensor assembly. Therefore, new low-cost electronics for such ion-sensitive field-effect transistors have been developed.

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Continuous Renal Replacement Therapies: A Brief Primer for the Neurointensivist

Cited by 19 publications

References 64 publications

Extracorporeal methods of blood glutamate scavenging: a novel therapeutic modality

Extracorporeal methods of blood glutamate scavenging: a novel therapeutic modality

Pearls & Oy-sters: The effects of renal replacement therapy on cerebral autoregulation

In-line monitoring of electrolytes and urea during continuous renal replacement therapy

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