Cytokine Clearances in Critically Ill Patients on Continuous Renal Replacement Therapy

Chen, Lingxin; Demirjian, Sevag; Udani, Suneel; Trevino, Sharon; Murray, Patrick; Koyner, Jay L.

doi:10.1159/000492025

Cited by 14 publications

(16 citation statements)

References 26 publications

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“…It is assumed that continuous venovenous haemofiltration (CVVH) leads to better clearance of larger molecules compared to continuous venovenous haemodialysis (CVVHD) due to solutes being dragged by the solvent. However, this has not been confirmed [21, 22]. In addition, clearance of larger molecules in CVVH may be impacted with time by clogging related to hemoconcentration inside the filter (depending on the filtration fraction).…”

Section: Resultsmentioning

confidence: 99%

Report of the first AKI Round Table meeting: an initiative of the ESICM AKI Section

Ostermann

Schneider

Rimmelé

et al. 2019

ICMx

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PurposeCritical Care Nephrology is an emerging sub-specialty of Critical Care. Despite increasing awareness about the serious impact of acute kidney injury (AKI) and renal replacement therapy (RRT), important knowledge gaps persist. This report represents a summary of a 1-day meeting of the AKI section of the European Society of Intensive Care Medicine (ESICM) identifying priorities for future AKI research.MethodsInternational Members of the AKI section of the ESICM were selected and allocated to one of three subgroups: “AKI diagnosis and evaluation”, “Medical management of AKI” and “Renal Replacement Therapy for AKI.” Using a modified Delphi methodology, each group identified knowledge gaps and developed potential proposals for future collaborative research.ResultsThe following key research projects were developed: Systematic reviews: (a) epidemiology of AKI with stratification by patient cohorts and diagnostic criteria; (b) role of higher blood pressure targets in patients with hypertension admitted to the Intensive Care Unit, and (c) specific clearance characteristics of different modalities of continuous renal replacement therapy (CRRT).Observational studies: (a) epidemiology of critically ill patients according to AKI duration, and (b) current clinical practice of CRRT.Intervention studies:( a) Comparison of different blood pressure targets in critically ill patients with hypertension, and (b) comparison of clearance of solutes with various molecular weights between different CRRT modalities.ConclusionConsensus was reached on a future research agenda for the AKI section of the ESICM.

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Section: Resultsmentioning

confidence: 99%

Report of the first AKI Round Table meeting: an initiative of the ESICM AKI Section

Ostermann

Schneider

Rimmelé

et al. 2019

ICMx

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“…However, to date, there have been no clinical outcome studies that favor convection versus diffusion-based modalities. 21 , 22 …”

Section: Discussionmentioning

confidence: 99%

The Production, Efficacy, and Safety of Machine-Generated Bicarbonate Solution for Continuous Venovenous Hemodialysis (CVVHD): The Cleveland Clinic Method

et al. 2021

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Rationale & Objective Since 1994, the Nephrology and Hypertension Department at the Cleveland Clinic has prepared and used bicarbonate-based solution for continuous venovenous hemodialysis (CVVHD) using a standard volumetric hemodialysis machine rather than purchasing from a commercial vendor. This report describes the process of producing Cleveland Clinic UltraPure Solution (CCUPS), quality and safety monitoring, economic costs, and clinical outcomes. Study Design Retrospective study. Setting & Participants CVVHD experience at Cleveland Clinic, focusing on dialysate production, institutional factors, and patients requiring continuous kidney replacement therapy. Production is shown at www.youtube.com/watch?v=WGQgephMEwA . Outcomes Feasibility, safety , and cost. Results Of 6,426 patients treated between 2011 and 2019 with continuous kidney replacement therapy, 59% were men, 71% were White, 40% had diabetes mellitus, and 74% presented with acute kidney injury. 98% of patients were treated with CVVHD using CCUPS, while the remaining 2% were treated with either continuous venovenous hemofiltration or continuous venovenous hemodiafiltration using commercial solution. The prescribed and delivered effluent doses were 24.8 (IQR) versus 20.7 mL/kg/h (IQR), respectively. CCUPS was as effective in restoring electrolyte and serum bicarbonate levels and reducing phosphate, creatinine, and serum urea nitrogen levels as compared with packaged commercial solution over a 3-day period following initiation of dialysis, with a comparable effluent dose. Among those with acute kidney injury, mortality was similar to that predicted with the 60-day acute kidney injury predicted mortality score (r = 0.997; CI: 0.989-0.999). At our institution, the cost of production for 1 L of CCUPS is $0.67, which is considerably less than the cost of commercially purchased fluid. Limitations Observational design without a rigorous control group. Conclusions CVVHD using locally generated dialysate is safe and cost-effective.

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“…Application of the dialyzing solution for CVVH is not required making this method more cost-effective. The authors [ 74 ] report similar ability of HF and HDF to eliminate cytokines. In the works devoted to CVVH for patients with multiple organ failure, there was noted reduced concentration of complement components, elimination of uremic toxins, cytokines, lipopolysaccharides, normalization of blood acid-base composition, the possibility to correct electrolyte and liquid balance, improvement of detoxification liver properties in adults and children [ 46 , 68 , 69 , 71 , 72 ].…”

Section: Hemofiltration and Hemodiafiltration In Severe Acute Pancreatitismentioning

confidence: 99%

“…It has been established that the majority of current filters for HF are capable of deposing active complement components, tumor necrosis factor, IL-6, IL-10, endotoxins of gram-negative bacteria on its surface [ 58 , 62 , 63 , 74 , 84 – 88 ]. Membranes from polymethyl methacrylate supplement the filtration clearance to the largest extent by the ability to stabilize the absorbed substances on its surface.…”

Section: Hemofiltration and Hemodiafiltration In Severe Acute Pancreatitismentioning

confidence: 99%

Hemofiltration in Patients with Severe Acute Pancreatitis (Review)

et al. 2020

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Questions regarding the application of extracorporeal detoxification to patients with severe acute pancreatitis have been considered. Hemodialysis, the historically first method of extracorporeal detoxification for such patients, has been also described in the review. Appropriateness of using renal replacement therapy methods and among them continued renal replacement therapy has been shown. Hemofiltration and hemodiafiltration technologies are described in detail including different modes of their application and the possibility of using various types of filters. Available data on hemofiltration for patients with severe acute pancreatitis have been analyzed. Great attention is paid to the unsolved aspects of hemofiltration in severe acute pancreatitis such as determining renal and extrarenal indices; time of starting hemofiltration; selection of volume replacement modes and a buffer system; procedure duration; anticoagulation measures, defining criteria to assess the adequacy of hemofiltration, state severity, and organ dysfunction degree. Further multicenter investigations are necessary to be able to assess the efficacy of the hemofiltration procedures on the basis of the thoroughly worked out and pathogenically grounded protocol using adequate control methods taking into consideration endogenic intoxication phases and intensity of the multiple organ failure syndrome.

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Cytokine Clearances in Critically Ill Patients on Continuous Renal Replacement Therapy

Cited by 14 publications

References 26 publications

Report of the first AKI Round Table meeting: an initiative of the ESICM AKI Section

Report of the first AKI Round Table meeting: an initiative of the ESICM AKI Section

The Production, Efficacy, and Safety of Machine-Generated Bicarbonate Solution for Continuous Venovenous Hemodialysis (CVVHD): The Cleveland Clinic Method

Hemofiltration in Patients with Severe Acute Pancreatitis (Review)

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