Extracorporeal CO<sub>2</sub> Removal May Improve Renal Function of Patients with Acute Respiratory Distress Syndrome and Acute Kidney Injury: An Open-Label, Interventional Clinical Trial

Fanelli, Vito; Cantaluppi, Vincenzo; Alessandri, Francesco; Costamagna, Andrea; Cappello, Paola; Brazzi, Luca; Pugliese, Francesco; Biancone, Luigi; Terragni, Pierpaolo; Ranieri, V. Marco

doi:10.1164/rccm.201712-2575le

Cited by 23 publications

(25 citation statements)

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“…A registry of patients combining ECMO/ECCO2R and RRT could improve understanding of current practice for initiating RRT in patients (adults and children) with ECMO/ECCO2R and fluid management. Respiratory dialysis (ECCO2R and ECMO) with modified dialysis solutions is currently limited to in vitro and experimental studies, [132][133][134] and research focused on this technical aspect is needed.…”

Section: Rrt In the Context Of Multi-organ Supportmentioning

confidence: 99%

Controversies in acute kidney injury: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Conference

Ostermann

Bellomo

Burdmann

et al. 2020

Kidney International

350

230

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I n 2012, Kidney Disease: Improving Global Outcomes (KDIGO) published a guideline on the classification and management of acute kidney injury (AKI). 1 Since then, new evidence has emerged that has important implications for clinical practice. Large epidemiology studies and risk profiles for AKI have become available in adults and children, such as the AKI-Epidemiologic Prospective Investigation (AKI-EPI) study, 2 the 0by25 Initiative, 3 the Southeast Asia-AKI (SEA-AKI) study, 4 and the Assessment of Worldwide Acute Kidney Injury, Renal Angina, and Epidemiology (AWARE) 5 and Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) 6 studies. The effectiveness of the KDIGO recommendations in preventing AKI has been confirmed in small single-center randomized controlled trials (RCTs), such as the Prevention of AKI (PrevAKI) 7 and the

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Section: Rrt In the Context Of Multi-organ Supportmentioning

confidence: 99%

Controversies in acute kidney injury: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Conference

Ostermann

Bellomo

Burdmann

et al. 2020

Kidney International

350

230

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“…However, permissive hypercapnia may have a negative effect on the kidney through reduced renal plasma flow and increased renal vascular resistance [119]. In theory, RRT helps compensate respiratory acidosis and may remove CO 2 through additional filters included in the CRRT circuit [extracorporeal CO 2 removal (ECCO 2 R)] [96,120,121]. While ECCO 2 R showed some benefit in a trial including 33 patients and may have aided application of ultraprotective ventilation among ARDS patients [122], another one was terminated due to insufficient CO 2 removal (PROVAP, clincialtrials.gov: NCT03004885).…”

Section: Rationalementioning

confidence: 99%

Lung–kidney interactions in critically ill patients: consensus report of the Acute Disease Quality Initiative (ADQI) 21 Workgroup

et al. 2019

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Background: Multi-organ dysfunction in critical illness is common and frequently involves the lungs and kidneys, often requiring organ support such as invasive mechanical ventilation (IMV), renal replacement therapy (RRT) and/or extracorporeal membrane oxygenation (ECMO). Methods:A consensus conference on the spectrum of lung-kidney interactions in critical illness was held under the auspices of the Acute Disease Quality Initiative (ADQI) in Innsbruck, Austria, in June 2018. Through review and critical appraisal of the available evidence, the current state of research, and both clinical and research recommendations were described on the following topics: epidemiology, pathophysiology and strategies to mitigate pulmonary dysfunction among patients with acute kidney injury and/or kidney dysfunction among patients with acute respiratory failure/acute respiratory distress syndrome. Furthermore, emphasis was put on patients receiving organ support (RRT, IMV and/or ECMO) and its impact on lung and kidney function. Conclusion:The ADQI 21 conference found significant knowledge gaps about organ crosstalk between lung and kidney and its relevance for critically ill patients. Lung protective ventilation, conservative fluid management and early recognition and treatment of pulmonary infections were the only clinical recommendations with higher quality of evidence. Recommendations for research were formulated, targeting lung-kidney interactions to improve care processes and outcomes in critical illness.

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“…In an open-label interventional clinical trial, FANELLI et al [137] showed that there could be an improvement in renal function and lower levels of inflammatory mediators using ECCO 2 R and continuous renal replacement therapy in patients with ARDS and acute kidney failure. The hypothesis is a possible "cross-talk" between the lung and kidney leading to reduced mechanical stress and, therefore, less inflammatory response.…”

Section: Take-home Messagesmentioning

confidence: 99%

ERS International Congress, Madrid, 2019: highlights from the Respiratory Intensive Care Assembly

et al. 2020

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The Respiratory Intensive Care Assembly of the European Respiratory Society is delighted to present the highlights from the 2019 International Congress in Madrid, Spain. We have selected four sessions that discussed recent advances in a wide range of topics: from acute respiratory failure to cough augmentation in neuromuscular disorders and from extra-corporeal life support to difficult ventilator weaning. The subjects are summarised by early career members in close collaboration with the Assembly leadership. We aim to give the reader an update on the most important developments discussed at the conference. Each session is further summarised into a short list of take-home messages.

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Extracorporeal CO₂ Removal May Improve Renal Function of Patients with Acute Respiratory Distress Syndrome and Acute Kidney Injury: An Open-Label, Interventional Clinical Trial

Cited by 23 publications

References 10 publications

Controversies in acute kidney injury: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Conference

Controversies in acute kidney injury: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Conference

Lung–kidney interactions in critically ill patients: consensus report of the Acute Disease Quality Initiative (ADQI) 21 Workgroup

ERS International Congress, Madrid, 2019: highlights from the Respiratory Intensive Care Assembly

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Extracorporeal CO2 Removal May Improve Renal Function of Patients with Acute Respiratory Distress Syndrome and Acute Kidney Injury: An Open-Label, Interventional Clinical Trial

Cited by 23 publications

References 10 publications

Controversies in acute kidney injury: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Conference

Controversies in acute kidney injury: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Conference

Lung–kidney interactions in critically ill patients: consensus report of the Acute Disease Quality Initiative (ADQI) 21 Workgroup

ERS International Congress, Madrid, 2019: highlights from the Respiratory Intensive Care Assembly

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Product

Resources

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Extracorporeal CO₂ Removal May Improve Renal Function of Patients with Acute Respiratory Distress Syndrome and Acute Kidney Injury: An Open-Label, Interventional Clinical Trial