How Does Continuous Renal Replacement Therapy Affect Septic Acute Kidney Injury?

Zhang, Jingxiao; Tian, Jiakun; Sun, Han‐Dong; Kumar, Dharmendra; Neri, Mauro; Bhargava, Vinant; Yin, Yongjie; Ronco, Claudio

doi:10.1159/000492026

Cited by 27 publications

(26 citation statements)

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“…This study shows that PaO 2 /FiO 2 of the children can reach 200 mmHg at 12 h and more than 300 mmHg at 24 h. The results showed that CRRT could improve tissue oxygenation and metabolism of sepsis-related AKI neonates by eliminating pulmonary interstitial edema, improving microcirculation and increasing the oxygen uptake capacity of parenchymal cells. Zhang et al [19] research has shown that CRRT could not only maintain fluid balance in vivo, excrete metabolites, but also clear inflammatory factors and promote renal recovery. The mechanism of CRRT in the treatment of sepsis-related AKI is as follows [20][21][22], CRRT can regulate renal metabolic adaptation and restoring renal function.…”

Section: Discussionmentioning

confidence: 99%

Clinical effect and safety of continuous renal replacement therapy in the treatment of neonatal sepsis-related acute kidney injury

et al. 2020

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Background: Sepsis is the leading cause of acute kidney injury (AKI) in the neonatal intensive care unit (NICU). The aim of the study is to explore the efficacy and security of continuous renal replacement therapy (CRRT) in the treatment of neonatal sepsis-related AKI. Method: Totally12 sepsis-related AKI neonates treated with CRRT were hospitalized in the NICU of Shanghai Children's Hospital between November 2012 and November 2019, and the clinical data of these 12 cases were retrospectively analyzed. Renal function, acid-base balance, electrolytes, blood pressure and hemodynamics indexes were recorded before CRRT initiation, 12/24/48 h after CRRT initiation and at the end of CRRT respectively. The efficacy of CRRT was evaluated and the clinical outcome was observed in these 12 sepsis-related AKI neonates. Repeated measurement analysis of variance was used for statistical analysis of the data. Result: (1) Continuous veno-venous hemodialysis filtration (CVVHDF) was used in 12 cases of sepsis-related AKI neonates. There were 6 cases with oliguria, 3 cases with fluid overload (FO), 3 cases with septic shock. The duration of CRRT was 49~110 h, average (76.2 ± 23.5) h. (2) The blood pressure (BP) of 12 sepsis-related AKI neonates could reach the normal level (40-60 mmHg) 12 h after CRRT initiation, and the normal BP level could be maintained during the CRRT treatment. After 12 h CRRT, the blood pH value increased to the normal range (7.35~7.45). After 12 h CRRT treatment, the oxygenation index of 12sepsis-related AKI neonates could reach 200 mmHg. After 24 h CRRT treatment, it could rise to more than 300 mmHg. Serum potassium, serum urea nitrogen and serum creatinine levels decreased significantly 12 h after CRRT initiation, and reached the normal range 24 h after CRRT initiation. The urine volume significantly increased 24 h after CRRT initiation. (3) Venous catheterization was performed successfully in all sepsis-related AKI neonates. We observed 2 cases of thrombocytopenia, 1 case of obstruction and 1 case of hypotension in the course of CRRT. There were no complications such as hypothermia, hemorrhage, thrombosis and infection.11 neonates were cured and discharged. One neonate was treated with CRRT and passed through the oliguria stage of AKI, but died after the parents gave up the treatment. Conclusions: It is safe and effective to treat neonatal sepsis-related AKI with CRRT, which should be an effective measure for the treatment of sepsis-related AKI neonates.

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Section: Discussionmentioning

confidence: 99%

Clinical effect and safety of continuous renal replacement therapy in the treatment of neonatal sepsis-related acute kidney injury

et al. 2020

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“…Cytokines are molecules that dissolve in water and are in free form in circulation. Their molecular weight is between 0.5-60 kDa (10). RRT filters are semi-permeable membranes with approximately 35 kDa pores (11).…”

Section: Introductionmentioning

confidence: 99%

“…Continuous renal replacement therapy (CRRT) with improvement in extracorporeal blood purification techniques and membrane materials are widely used in critical illness(10). The theoretical cut-off for an RRT membrane is about 35 kDa.…”

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Evaluation of the Effectiveness of Continuous Venovenous Hemodiafiltration Appli̇ed With Oxiris and AN69 Membranes in Patients With Septic Shock-Related Acute Kidney Injury

Kaçar¹,

Uzundere²,

Yüksel³

et al. 2020

Preprint

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Background and objectives: AN69 and Oxiris are filters used in continuous renal replacement therapy. In this study, we aimed to research the effects of these filters on blood cell counts, blood biochemistry, inflammation indicators, clinical status and mortality of patients diagnosed with septic shock-related acute kidney injury. Method: Between March 2019 and October 2019, 42 adult patients (Group 1: Oxiris (n = 21) or Group 2: AN69 (n=21)) with septic shock-related acute kidney injury and received continuous venovenous hemodiafiltration (CVVHDF) in the intensive care unit were included in the study and their results were prospectively observed and compared. The data at the begining of CVVHDF (pre-CVVHDF) and 24 hours after the onset of CVVHDF (post-CVVHDF) were recorded.Results: In the comparison of the pre- and post-CVVHDF values in Group 1, there was a statistically significant decrease detected in the procalcitonin (p = 0.04) and noradrenaline infusion rate (p = 0.02) levels. In terms of the other data there was no statistically significant difference between pre- and post-CVVHDF values in Group 1. In the comparison of the pre- and post-CVVHDF values in Group 2, there was a statistically significant decrease detected in the urea (p = 0.04), platelet count (p = 0.02) and procalcitonin (p = 0.002) levels. There was no statistically significant difference between pre- and post-CVVHDF values in terms of the other data in Group 2. There was no statistically significant difference between the groups in terms of mortality. Conclusions: CVVHDF with Oxiris filter causes a statistically significant decrease in noradrenaline infusion rate. Therefore, we think that the use of CVVHDF with Oxiris filter applied for septic shock-related acute kidney injury will save us time and increase the improvement in the treatment.

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“…Sepsis is the most common cause of acute kidney injury (AKI) in intensive care patients and an independent predictor of poor outcome [17]. Continuous renal replacement therapy (CRRT) is a standard to preserve hemodynamic stability.…”

Section: Introductionmentioning

confidence: 99%

High-dose CytoSorb hemoadsorption is associated with improved survival in patients with septic shock: A retrospective cohort study

Schultz

Schwier

Eickmeyer

et al. 2020

Preprint

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Background: Septic shock and SIRS are life-threatening diseases with persistent high mortality. Hemoadsorption with CytoSorb® offers a possible therapeutic approach, but the optimal timing, dosing and indications are still unclear.Methods: Observational data from 70 patients with septic shock or SIRS, treated in a university hospital with hemoadsorption by CytoSorb® in addition to renal replacement therapy were analyzed retrospectively. Physiologic parameters and clinical outcomes were extracted from the electronic charts. The predicted mortality was calculated based on APACHE II and SOFA scores and compared with the actual 28-day survival. The total amount of blood purified was correlated with outcome.Results: The main origins of septic shock were abdominal (n=29) or pulmonary (n=22). The mean age was 70.6±13.3 years. Hemoadsorption was applied for 85.6±53.8h with 3.2±1.7 cycles lasting 26.75±11.1h each. The severity was characterized by a mean APACHE II score of 30.2±6.3 and SOFA score of 13.8±3.5, which calculated to a predicted mortality of 73.3% and 62.1%, respectively. The observed mortality was significantly lower (35/70 patients (50%), p<0.05). Interleukin-6 levels at baseline were high (survivors: 7964±11242pg/ml; nonsurvivors: 8.755±15.800pg/ml, p=0.27) and decreased rapidly within 4-24h. Survival was independently associated with lower IL-6 levels and norepinephrine dosage after 24h. An increase in IL-6 after 48h was predictive of poor outcome.The treatment duration and amount of blood purified was higher in survivors than in non-survivors (8.47±4.42 vs. 6.07±3.57l/kg BW, p=0.017). We identified 3 clusters of <6l/kg, 6-13l/kg and ≥13l/kg BW with a linear dose-response relation between blood purification volume and survival. Although the predicted mortality was comparable among the clusters (p=ns), survival was best in the highest volume cluster (16.7%; p=0.045).Conclusions: The application of CytoSorb® seems to be safe and effective in various conditions of septic shock and SIRS, although the optimal duration and dosing remain unclear. In a cohort of severely ill patients the observed mortality rate was lower than predicted and decreased linearly with blood purification volumes exceeding 6l/kg BW. These results suggest that hemoadsorption with CytoSorb® improves survival in septic shock or SIRS, provided that the applied dose is high enough.

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How Does Continuous Renal Replacement Therapy Affect Septic Acute Kidney Injury?

Cited by 27 publications

References 50 publications

Clinical effect and safety of continuous renal replacement therapy in the treatment of neonatal sepsis-related acute kidney injury

Clinical effect and safety of continuous renal replacement therapy in the treatment of neonatal sepsis-related acute kidney injury

Evaluation of the Effectiveness of Continuous Venovenous Hemodiafiltration Appli̇ed With Oxiris and AN69 Membranes in Patients With Septic Shock-Related Acute Kidney Injury

High-dose CytoSorb hemoadsorption is associated with improved survival in patients with septic shock: A retrospective cohort study

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