Continuous Renal Replacement Therapy

Abstract

SUMMARY -Acute renal failure (ARF) is currently more frequently seen as part of a more complex syndrome defined by sepsis and/or multiple organ failure. Evolution in the field of hemodialysis has led to a parallel development of new systems for continuous renal replacement therapy (CRRT) in critically ill patients. The various CRRT modalities differ in the type of vascular access, application of diffusive or convective clearance (or a combination of both), and location where the replacement fluid enters the circuit. CRRTs have certainly facilitated the management of critically ill patients with ARF combined with cardiovascular instability, severe fluid overload, hypercatabolism, cerebral edema, adult respiratory distress syndrome, lactic acidosis, sepsis or other inflammatory syndromes, crush syndrome, congestive heart failure, and cardiopulmonary bypass. Continuous therapies incorporate several advantages including improved hemodynamic stability, optimal fluid balance, gradual urea removal, elimination of septic mediators, and the possibility of unlimited parenteral nutrition. Major difficulties and unsolved problems of CRRT are the ongoing necessity for continuous anticoagulation, considerable loss of amino acids, vitamins, trace elements, potassium, phosphate, and some drugs as well as immobilization of the patient. The advantages of CRRT should theoretically translate into improved outcomes of critically ill ARF patients, but the superiority of continuous modalities in terms of outcomes is still controversial, despite encouraging results in some clinical trials.

Effectiveness of extracorporeal blood purification (hemoadsorption) in patients with severe coronavirus disease 2019 (COVID-19)

“…Jugular temporary catheter (Bard trademark) was placed by a vascular surgeon. Heparin has been injected as an anticoagulant agent throughout the CRRT by the arterial line depending on the patient's coagulation status [14]. The blood flow rate (QB) was 200-250 mL/minute, the hemofiltration fluid flow rate (QD) 2Lit/hour, and the effluent volume was 2lit/hour.…”

Use of hepatic support with MARS in a patient with SARS-CoV-2 Pneumonia, in treatment with ECMO and CRRT therapies: Case Report

“…The use of Extracorporeal Membrane Oxygenation (ECMO) therapy has increased significantly since the emergence of COVID-19 pneumonia. In critically ill patients with multiple organ failure (MOF), the combination of therapies known as Extracorporeal Organ Support (ECOS) is becoming increasingly common [1,2] The following describes a patient who required ECOS starting with ECMO, followed by Continuous Renal Replacement Therapy (CRRT), and finally liver support therapy with the Molecular Absorbent Recirculation System (MARS) for severe hyperbilirubinemia. CRRT and MARS were performed while the patient remained on ECMO.…”

“…Another important fact is that in our patient, in addition to ECMO, (due to MOF) other support therapies were used, such as CRRT and the molecular adsorbent recirculation system (MARS Ò , Gambro, Stockholm, Sweden); which consists of an extrahepatic clearance system in patients with severe liver failure who presented hyperbilirubinemia, as well as being useful for the elimination of albumin-bound toxins and soluble toxins. The MARS circuit consists of, an albumin hemodialyzer (MARS flux), a standard high flux hemodialyzer (CRRT), an activated carbon adsorber, and an anion exchanger column [2,3].…”