Implementing On-Line Hemodiafiltration as a Renal Replacement Therapy for ICU Acute Renal Failure: A Single-Center Report of Feasibility, Safety and Hemodynamic Tolerance over a Seven-Year Period

Klouche, Kada; Amigues, Laurent; Serveaux-Delous, Marianne; Machado, Sonia Salgueiro; Delabre, Jean-Philippe; Laydet, Erick; Mauran, P.; Jonquet, O.; Canaud, Bernard

doi:10.1159/000338960

Cited by 5 publications

(19 citation statements)

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“…The choice of RRT modality was depending on patient hemodynamic stability and was daily re-evaluated. Patients with hemodynamic instability or severe fluid overload were preferentially treated with pre-dilutional continuous venovenous hemodiafiltration (CVVHDF) or on-line sustained low-efficiency daily dialysis-filtration (SLEDD-f), and those with hemodynamic stability were preferentially treated with on-line intermittent hemodiafiltration (IHDF) [ 27 ].…”

Section: Methodsmentioning

confidence: 99%

Daily urinary creatinine predicts the weaning of renal replacement therapy in ICU acute kidney injury patients

Viallet¹,

Brunot²,

Kuster

et al. 2016

Ann. Intensive Care

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BackgroundIn acute kidney injury (AKI), useless continuation of renal replacement therapy (RRT) may delay renal recovery and impair patient’s outcome. In this study, we aimed to identify predictive parameters that may help to a successful RRT weaning for AKI patients.MethodsWe studied 54 surviving AKI patients in which a weaning of RRT was attempted. On the day of weaning (D0) and the following 2 days (D1 and D2), SAPS II and SOFA scores, 24-h diuresis, 24-h urinary creatinine and urea (UCr and UUr), creatinine and urea generation rates (CrGR and UrGR) and clearances (CrCl and UrCl) were collected. Patients who remained free of RRT 15 days after its discontinuation were considered as successfully weaned.ResultsTwenty-six RRT weaning attempts succeeded (S+) and 28 failed (S−). Age, previous renal function, SAPS II and SOFA scores were comparable between groups. At D0, 24-h diuresis was 2300 versus 1950 ml in S+ and S−, respectively, p = 0.05. At D0, D1 and D2, 24-h UUr and UCr levels, UrCl and CrCl, and UUr/UrGR and UCr/CrGR ratios were significantly higher in S+ group. By multivariate analysis, D1 24-h UCr was the most powerful parameter that was associated with RRT weaning success with an area under the ROC curve of 0.86 [0.75–0.97] and an odds ratio of 2.01 [1.27–3.18], p = 0.003.ConclusionsIn ICU AKI, 24-h UCr appeared as an efficient and independent marker of a successful weaning of RRT. A 24-h UCr ≥5.2 mmol was associated with a successful weaning in 84 % of patients.

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Section: Methodsmentioning

confidence: 99%

Daily urinary creatinine predicts the weaning of renal replacement therapy in ICU acute kidney injury patients

Viallet¹,

Brunot²,

Kuster

et al. 2016

Ann. Intensive Care

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“…Our ICU water production and distribution system was identical to that routinely used in chronic dialysis facilities performing on-line therapies [ 21 ] as previously described [ 11 ]. Dialysate and infusate purity has been also validated previously [ 9 , 11 , 22 ] and was ensured by regular endotoxin and microbiological testing. Vascular access was obtained through double lumen jugular catheter, with unfractionated heparin for anticoagulation whenever needed.…”

Section: Methodsmentioning

confidence: 99%

“…In chronic dialysis facilities, this technique became a routine and safe modality of RRT and now represents the most effective dialysis therapy [ 8 – 10 ]. A few reports exist about its use in ICUs and its routine application is mainly restricted to ICU facilities working with a trained nephrological team [ 4 – 7 , 11 – 17 ]. The limited use of this technique by intensivists is largely related to the technical complexity with water treatment and HDF machines and to the potential infectious risk of on-line produced fluids infusion especially in septic patients who represent the majority of admissions in ICUs.…”

Section: Introductionmentioning

confidence: 99%

“…The limited use of this technique by intensivists is largely related to the technical complexity with water treatment and HDF machines and to the potential infectious risk of on-line produced fluids infusion especially in septic patients who represent the majority of admissions in ICUs. We have previously reported our experience of OL-HDF use in ICU [ 11 ]. A regular bacteriological control of dialysis fluids showed that this technique is safe and well tolerated [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…We have previously reported our experience of OL-HDF use in ICU [ 11 ]. A regular bacteriological control of dialysis fluids showed that this technique is safe and well tolerated [ 11 ]. Whether OL-HDF modulates plasma cytokine concentration and oxidative stress production is still not investigated.…”

Section: Introductionmentioning

confidence: 99%

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On-line hemodiafiltration did not induce an overproduction of oxidative stress and inflammatory cytokines in intensive care unit-acute kidney injury

et al. 2017

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BackgroundThough on-line intermittent hemodiafiltration (OL-IHDF) is a routine therapy for chronic dialysis patients, it is not yet widespread used in critically ill patients. This study was undergone to evaluate efficiency and tolerance of OL-IHDF and to appreciate inflammatory consequences of its use in intensive care unit (ICU)-acute kidney injury (AKI) patients.MethodsIn this prospective cohort study conducted in a medical academic ICU in France, 30 AKI patients who underwent OL-IHDF were included. OL-HDF used an ultrapure water production: AQ 1250 line with double reverse osmosis, a generator 5008 with a 1.8m2 dialyzer with Polysulfone membrane (Fresenius Medical Care). Tolerance and efficiency of OL-IHDF were evaluated as well as its inflammatory risk by the measurement of plasma concentrations of proinflammatory (Interleukin 6, IL1β, IL8, Interferon γ) and anti-inflammatory (IL4, IL10) cytokines, Epidermal growth factor (EGF), Vascular Endothelial growth factor (VEGF) and Macrophage Chemoattractive Protein-1 (MCP-1) before and after sessions.ResultsIntradialytic hypotensive events were observed during 27/203 OL-IHDF sessions accounting for a mal-tolerated session’s rate at 13.3%. Mean delivered urea Kt/V per session was 1.12 ± 0.27 with a percentage of reduction for urea, creatinine, β2-microglobulin and cystatine C at 61.6 ± 8.8%, 55.3 ± 6.7%, 51.5 ± 8.7% and 44.5 ± 9.8% respectively. Production of superoxide anion by leukocytes, mean levels of pro- and anti-inflammatory cytokines and plasmatic concentrations of EGF, VEGF and MCP-1 did not differ before and after OL-IHDF sessions. We observed however a significant decrease of mean TNFα plasmatic concentrations from 8.2 ± 5.8 to 4.8 ± 3.5 pg/ml at the end of OL-IHDF.ConclusionsOL-IHDF was not associated with an increase in pro and anti-inflammatory cytokines, oxidative stress or EGF, VEGF and MCP-1 in AKI patients and seems therefore a secure and feasible modality in ICUs.

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Intermittent Convective Therapies in Patients with Acute Kidney Injury: A Systematic Review with Meta-Analysis

et al. 2021

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Introduction: In critically ill patients requiring intermittent renal replacement therapy (RRT), the benefits of convective versus diffusive clearance remain uncertain. We conducted a systematic review and meta-analysis to determine the safety, clinical efficacy, and clearance efficiency of hemofiltration (HF) and hemodiafiltration (HDF) compared to hemodialysis (HD) in patients with acute kidney injury (AKI) receiving intermittent RRT. Method: We searched Medline, Embase, Cochrane Library, and PROSPERO. We included clinical trials and observational studies that reported the use of intermittent HF or HDF in adult patients with AKI. The following outcomes were included: mortality, renal recovery, clearance efficacy, intradialytic hemodynamic stability, circuit loss, and inflammation modulation. Results: A total of 3,169 studies were retrieved and screened. Four randomized controlled trials and 4 observational studies were included (n: 615 patients). Compared with conventional HD, intermittent convective therapies had no effect on in-hospital mortality (relative risk, 1.23; 95% confidence interval (CI), 0.76–1.99), renal recovery at 30 days (RR, 0.98; 95% CI, 0.82–1.16), time-to-renal recovery (mean difference [MD], 0.77; 95% CI, −6.56 to 8.10), and number of dialysis sessions until renal recovery (MD, −1.34; 95% CI, −3.39 to 0.72). The overall quality of included studies was low, and dialysis parameters were suboptimal for all included studies. Conclusion: This meta-analysis suggests that there is no significant difference in short-term mortality and renal recovery in patients with severe AKI when treated with intermittent HF or HDF compared to conventional HD. This systematic review emphasizes the need for further trials evaluating optimal convective parameters in AKI patients treated with intermittent dialysis.

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Implementing On-Line Hemodiafiltration as a Renal Replacement Therapy for ICU Acute Renal Failure: A Single-Center Report of Feasibility, Safety and Hemodynamic Tolerance over a Seven-Year Period

Cited by 5 publications

References 61 publications

Daily urinary creatinine predicts the weaning of renal replacement therapy in ICU acute kidney injury patients

Daily urinary creatinine predicts the weaning of renal replacement therapy in ICU acute kidney injury patients

On-line hemodiafiltration did not induce an overproduction of oxidative stress and inflammatory cytokines in intensive care unit-acute kidney injury

Intermittent Convective Therapies in Patients with Acute Kidney Injury: A Systematic Review with Meta-Analysis

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