Data Analytics for Continuous Renal Replacement Therapy: Historical Limitations and Recent Technology Advances

Clark, William R.; Garzotto, Francesco; Neri, Mauro; Lorenzin, Anna; Zaccaria, Marta; Ronco, Claudio

doi:10.5301/ijao.5000522

Cited by 14 publications

(12 citation statements)

References 24 publications

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“…The ADQI group has recently recommended the use of modern information technology (IT) tools to improve practice and patient care. Such tools can be used for data acquisition and storage but also for treatment monitoring ( 62 ). Manual, authorized or automatic feedback technology is available today in chronic dialysis machines and has been advocated for CRRT machines as well.…”

Section: Information Technology and Connectivitymentioning

confidence: 99%

Continuous Renal Replacement Therapy: Forty-year Anniversary

Ronco

2017

Int J Artif Organs

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In 1977 Peter Kramer performed the first CAVH (continuous arteriovenous hemofiltration) treatment in Gottingen, Germany. CAVH soon became a reliable alternative to hemo- or peritoneal dialysis in critically ill patients. The limitations of CAVH spurred new research and the discovery of new treatments such as CVVH and CVVHD (continuous veno-venous hemofiltration and continuous veno-venous hemodialysis). The alliance with industry led to development of new specialized equipment with improved accuracy and performance in delivering continuous renal replacement therapies (CRRTs). Machines and filters have progressively undergone a series of technological steps, reaching a high level of sophistication. The evolution of technology has continued, leading to the development and clinical application of new membranes, new techniques and new treatment modalities. With the progress of technology, the entire field of critical care nephrology moved forward, expanding the areas of application of extracorporeal therapies to cardiac, liver and pulmonary support. A great deal of research made extracorporeal therapies an interesting option for the treatment of sepsis and intoxication and the additional use of sorbents was explored. With the progress in understanding the pathophysiology of acute kidney injury (AKI), new guidelines were developed, driving indications, modalities of prescription, monitoring techniques and quality assurance programs. Information technology and precision medicine have recently contributed to further evolution of CRRT, with the possibility of collecting data in large databases and evaluating policies and practice patterns. This is likely to ultimately result in improved patient care. CRRTs are 40 years old today, but they are still young and full of potential for further evolution.

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Section: Information Technology and Connectivitymentioning

confidence: 99%

Continuous Renal Replacement Therapy: Forty-year Anniversary

Ronco

2017

Int J Artif Organs

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“…In addition to ongoing clinical assessment of the patient, important technical components of dynamic CRRT include solute clearance, delivered/prescribed dose, effective treatment time, solute control indicators, circuit/filter pressure trends, fluid and hemodynamic management, and anticoagulation. Also assuming important roles in the implementation of precision CRRT are quality metrics [8], biofeedback [9], and data analytics [10], all of which are discussed further in the following.…”

Section: Renal Support In 2027: Addressing Crrt’s Current Limitationsmentioning

confidence: 99%

“…The technical limitations of current CRRT machines make efficient management of patient and treatment data difficult in some respects [10]. As opposed to the automated, real-time data capture that characterizes many interventions in the ICU, CRRT machine data generally are collected and analyzed manually at present.…”

Section: Renal Support In 2027: Addressing Crrt’s Current Limitationsmentioning

confidence: 99%

The future of critical care: renal support in 2027

et al. 2017

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Since its inception four decades ago, both the clinical and technologic aspects of continuous renal replacement therapy (CRRT) have evolved substantially. Devices now specifically designed for critically ill patients with acute kidney injury are widely available and the clinical challenges associated with treating this complex patient population continue to be addressed. However, several important questions remain unanswered, leaving doubts in the minds of many clinicians about therapy prescription/delivery and patient management. Specifically, questions surrounding therapy dosing, timing of initiation and termination, fluid management, anticoagulation, drug dosing, and data analytics may lead to inconsistent delivery of CRRT and even reluctance to prescribe it. In this review, we discuss current limitations of CRRT and potential solutions over the next decade from both a patient management and a technology perspective. We also address the issue of sustainability for CRRT and related therapies beyond 2027 and raise several points for consideration.

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“…Dialysis is the most commonly used method for treatment of acute renal failure (ARF) [ 6 ]. There are several modalities of dialysis, including continuous renal replacement therapy (CRRT) [ 7 ], intermittent renal replacement therapy (IRRT), and peritoneal dialysis. CRRT is the major method used for treatment of ARF, mainly because it is associated with better hemodynamic tolerance [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Artificial Liver and Renal Support System for Cynomolgus Monkeys with Surgery-Induced Acute Renal Failure: A Preclinical Study

Feng

Cai

et al. 2018

BioMed Research International

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Renal dysfunction is one of the most common complications of liver cirrhosis and is associated with increased morbidity and mortality. However, no available technology can simultaneously support liver and renal function in these patients. The aim of this study was to evaluate the safety and efficacy of an artificial liver and renal support system in cynomolgus monkeys with surgery-induced ARF. The ARF model was established by ligature of bilateral renal arteries in eight cynomolgus monkeys, which were randomly divided into a treatment group (n = 4) and control group (n = 4). Biochemical indexes were determined before and after surgery. Blood endotoxin levels, biochemical indexes, and bacterial cultures were assessed at 0, 3, and 6 h during treatment. System pressures and vital signs were recorded at 1 h intervals. Pathological examination was performed after death. ARF was successfully established, based on significant elevation of biochemical indexes and pathological examination. The treatment group had significantly reduced biochemical indexes relative to the control group. Measurement of blood endotoxins and aerobic and anaerobic bacteria cultures indicated no bacterial growth. The system pressures and vital signs were stable during treatment. The results indicate that our support system for the treatment of cynomolgus monkeys with surgery-induced acute renal failure is safe and effective.

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Data Analytics for Continuous Renal Replacement Therapy: Historical Limitations and Recent Technology Advances

Cited by 14 publications

References 24 publications

Continuous Renal Replacement Therapy: Forty-year Anniversary

Continuous Renal Replacement Therapy: Forty-year Anniversary

The future of critical care: renal support in 2027

Artificial Liver and Renal Support System for Cynomolgus Monkeys with Surgery-Induced Acute Renal Failure: A Preclinical Study

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