Continuous renal replacement therapy under special conditions like sepsis, burn, cardiac failure, neurotrauma, and liver failure

Abstract

Continuous renal replacement therapy (CRRT) in sepsis does have a role in removing excessive fluid, and also role in removal of mediators although not proven today, and to allow fluid space in order to feed. In these conditions, continuous renal replacement therapy can improve morbidity but never mortality so far. Regarding sepsis, timing has become a more important issue after decades and is currently more discussed than dosing. Rationale of blood purification has evolved a lot in the last years regarding sepsis with the discovery of many types of sorbent allowing ideas from science fiction to become reality in 2021. Undoubtedly, COVID-19 has reactivated the interest of blood purification in sepsis but also in COVID-19. Burn is even more dependent about removal of excessive fluid as compared to sepsis. Regarding cardiac failure, ultrafiltration can improve the quality of life and morbidity when diuretics are becoming inefficient but can never improve mortality. Regarding brain injury, CRRTs have several advantages as compared to intermittent hemodialysis. In liver failure, there have been no randomized controlled trials to examine whether single-pass albumin dialysis offers advantages over standard supportive care, and there is always the cost of albumin.

Continuous Renal Replacement Therapy for Hypertension Complicated by Refractory Heart Failure: An Analysis of Safety and Nursing Highlights

“…CRRT, as a blood purification technology widely used in clinical practice, has achieved remarkable results in the cardiovascular field [ 20 ]. CRRT has been found to reduce cardiac load, stabilize CF, restore the body's (especially kidney) sensitivity to diuretics, and improve oxygen supply and RHF status [ 21 ].…”

A bibliometric analysis of publications on burn sepsis using VOSviewer

“…Accordingly, sepsis treatment in burn patients ( 36 ) is broadly divided into the following aspects: 1. fluid resuscitation ( 37 ), 2. anti-infection treatment surgical removal of traumatic necrotic tissue, etc. ( 31 , 36 ), 3. renal replacement therapy ( 38 ), 4. immune conditioning strategies ( 39 ), 5. adjuvant support and symptomatic treatment, which includes correction of hyperglycemia and electrolyte disorders according to the patient's status; early enteral or parenteral nutrition and reasonable nutritional support; cautious application of glucocorticoids to avoid infection aggravation; and strengthening of adjuvant support therapy for vital organ functions to prevent the occurrence and development of MODS, etc. ( 40 ).…”

An Innovative Approach to Minimizing Downtime in Continuous Kidney Replacement Therapy

“…29,30 Other patient populations for whom shortened filter life span secondary to clotting or clogging might present a clinical challenge include those with sepsis, burns, or liver failure. 21,27,31,32 Existing Technology to Reduce Clotting and Clogging Optimizing filter life and performance efficiency are key to reducing downtime, improving outcomes, and reducing the cost of CKRT. 27 Beyond systemic and regional anticoagulation, multiple technologies have been developed to reduce clotting.…”