Effects of Dialysis Modality on Blood Loss, Bleeding Complications and Transfusion Requirements in Critically Ill Patients with Dialysis-Dependent Acute Renal Failure

Abstract

Blood loss and bleeding complications may often be observed in critically ill patients on renal replacement therapies (RRT). Here we investigate procedural (i.e. RRT-related) and non-procedural blood loss as well as transfusion requirements in regard to the chosen mode of dialysis (i.e. intermittent haemodialysis [IHD] versus continuous veno-venous haemofiltration [CVVH]). Two hundred and fifty-two patients (122 CVVH, 159 male; aged 61.5±13.9 years) with dialysis-dependent acute renal failure were analysed in a sub-analysis of the prospective randomised controlled clinical trial-CONVINT-comparing IHD and CVVH. Bleeding complications including severity of bleeding and RRT-related blood loss were assessed. We observed that 3.6% of patients died related to severe bleeding episodes (between group P=0.94). Major all-cause bleeding complications were observed in 23% IHD versus 26% of CVVH group patients (P=0.95). Under CVVH, the rate of RRT-related blood loss events (57.4% versus 30.4%, P=0.01) and mean total blood volume lost was increased (222.3±291.9 versus 112.5±222.7 ml per patient, P <0.001). Overall, transfusion rates did not differ between the study groups. In patients with sepsis, transfusion rates of all blood products were significantly higher when compared to cardiogenic shock (all P <0.01) or other conditions. In conclusion, procedural and non-procedural blood loss may often be observed in critically ill patients on RRT. In CVVH-treated patients, procedural blood loss was increased but overall transfusion rates remained unchanged. Our data show that IHD and CVVH may be regarded as equivalent approaches in critically ill patients with dialysis-dependent acute renal failure in this regard.

Anemia, Blood Transfusion, and Filter Life Span in Critically Ill Patients Requiring Continuous Renal Replacement Therapy for Acute Kidney Injury: A Case-Control Study

“…Other studies have shown different results. One study observed that baseline anemia (<120 g/L in women and <135 g/L in men) before starting CRRT for AKI was present in 83% with hemoglobin level dropping by 5% in the subsequent 7 days [17]. Another study found that new onset anemia (hemoglobin <100 g/L) during CRRT occurred in 31% [18].…”

Transfusion in critical care: Past, present and future

“…Excessive blood sampling has been discussed previously. Renal replacement therapy, and its associated anticoagulation regime and filter circuit changes, is another important cause of iatrogenic anaemia, with one study reporting a mean (SD) loss of up to 384.3 (291.7) ml over 7 days 85 . Many medications given to critically ill patients have side effects that can cause haemolysis and thrombocytopenia and impair erythropoiesis and haemostasis (Table 4).…”

Outcomes of Prophylactic Pantoprazole in Adult Intensive Care Unit Patients Receiving Dialysis: Results of a Randomized Trial

“…In critically ill patients with acute kidney injury (AKI), the incidence of GI bleeding may be increased due to uremia-induced effects on platelets and coagulation cascades [4][5][6][7][8][9]. In addition, renal replacement therapy (RRT) is known to activate the coagulation cascades via contact of patient blood with foreign material and RRT often requires anticoagulation [5][6][7][8][9][10][11][12][13][14].…”

“…In critically ill patients with acute kidney injury (AKI), the incidence of GI bleeding may be increased due to uremia-induced effects on platelets and coagulation cascades [4][5][6][7][8][9]. In addition, renal replacement therapy (RRT) is known to activate the coagulation cascades via contact of patient blood with foreign material and RRT often requires anticoagulation [5][6][7][8][9][10][11][12][13][14]. AKI is frequently observed in ICU patients and significantly affects morbidity and mortality [4,[14][15][16], and previous data comparing continuous versus intermittent RRT modalities in critically ill patients have indicated that up to 30% of adult RRT-treated general ICU patients may experience clinically important allcause bleeding episodes during ICU stay [7,17].…”