Prescribing Continuous Kidney Replacement Therapy in Acute Kidney Injury: A Narrative Review

Verma, Siddharth; Palevsky, Paul M.

doi:10.1016/j.xkme.2021.05.006

Cited by 6 publications

(4 citation statements)

References 73 publications

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“…In the era of RCA, the anticoagulation effect of citrate and the low filtration fraction cannot be guaranteed at the same time in CVVH mode. Under comprehensive evaluation of the FF and the solute removal ability of CRRT, CVVHDF and citrate anticoagulation may be the best partners [18,19]. Previous studies have shown that using commercial Ca-containing solution was a simplified and efficient method of RCA for CVVHDF [20,21].…”

Section: Discussionmentioning

confidence: 99%

Safety and Feasibility of Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy With Calcium‐Containing Solutions: A Randomized Controlled Trial

Huang,

Sun,

et al. 2024

Seminars in Dialysis

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BackgroundCalcium‐free (Ca‐free) solutions are theoretically the most ideal for regional citrate anticoagulation (RCA) in continuous renal replacement therapy (CRRT). However, the majority of medical centers in China had to make a compromise of using commercially available calcium‐containing (Ca‐containing) solutions instead of Ca‐free ones due to their scarcity. This study was designed to probe into the potential of Ca‐containing solution as a secure and efficient substitution for Ca‐free solutions.MethodsIn this prospective, randomized single‐center trial, 99 patients scheduled for CRRT were randomly assigned in a 1:1:1 ratio to one of three treatment groups: continuous veno‐venous hemodialysis Ca‐free dialysate (CVVHD Ca‐free) group, continuous veno‐venous hemodiafiltration calcium‐free dialysate (CVVHDF Ca‐free) group, and continuous veno‐venous hemodiafiltration Ca‐containing dialysate (CVVHDF Ca‐containing) group at cardiac intensive care unit (CICU). The primary endpoint was the incidence of metabolic complications. The secondary endpoints included premature termination of treatment, thrombus of filter, and bubble trap after the process.ResultsThe incidence of citrate accumulation (18.2% vs. 12.1% vs. 21.2%) and metabolic alkalosis (12.1% vs. 0% vs. 9.1%) did not significantly differ among three groups (p > 0.05 for both). The incidence of premature termination was comparable among the groups (18.2% vs. 9.1% vs. 9.1%, p = 0.582). The thrombus level of the filter and bubble trap was similar in the three groups (p > 0.05 for all).ConclusionsIn RCA‐CRRT for CICU population, RCA‐CVVHDF with Ca‐containing solutions and traditional RCA with Ca‐free solutions had a comparable safety and feasibility.Trial Registration: ChiCTR2100048238 in the Chinese Clinical Trial Registry.

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Section: Discussionmentioning

confidence: 99%

Safety and Feasibility of Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy With Calcium‐Containing Solutions: A Randomized Controlled Trial

Huang,

Sun,

et al. 2024

Seminars in Dialysis

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“…Due to the progression of kidney damage, in most cases renal replacement therapy (RRT) is required, which can include intermittent hemodialysis, peritoneal dialysis, hemofiltration, prolonged intermittent renal replacement therapy and continuous renal replacement therapy [9][10] . Intermittent hemodialysis is chosen in the vast majority of cases 11 . Patients with acute or chronic kidney disease have other associated comorbidities, and their presence requires the use of medications to control them.…”

Section: Rbfhssmentioning

confidence: 99%

Ajuste posológico na insuficiência renal: comparação entre bases de dados

MARANHÃO,

DOMINGUES,

ARAUJO

2024

Rev Bras Farm Hosp Serv Saude

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Objetivo: Comparar as informações fornecidas por três bases de dados referentes ao ajuste posológico na insuficiência renal dos medicamentos padronizados em um hospital de ensino brasileiro da região Centro-Oeste. Método: Trata-se de um estudo documental, descritivo e analítico com abordagem qualitativa a partir da análise de informações dos medicamentos padronizados no referido hospital. As principais variáveis coletadas foram: (i) necessidade de ajuste da dose do medicamento com base na função renal; (ii) informação quanto a dialisação do medicamento. A concordância entre as bases foi analisada calculando o coeficiente kappa (k) de Cohen que mede a concordância entre dois observadores. Foi avaliada a concordância da informação quanto ao ajuste posológico e se o medicamento seria removido na hemodiálise. Resultados: Foram incluídos 262 medicamentos (81,9% dos padronizados na instituição). O UpToDate® apresentou informação para um número maior de medicamentos, sendo 228 medicamentos (87%) para ajuste renal e 185 medicamentos (70,6%) para o comportamento durante diálise. O Micromedex® foi a base com informação para a menor quantidade de medicamentos. Com relação a comparação entre as bases de dados referente ao ajuste posológico, observou-se uma concordancia moderada entre UptoDate® e Micromedex® (k=0,474) e uma concordância razoável entre UpToDate® e Whitebook® (k=0,379). Na análise comparativa quanto ao comportamento dos medicamentos durante diálise, tanto UpToDate® e Micromedex® quanto UpToDate® e Whitebook® apresentaram concordância fraca (k=0,188 e k=0,187, respectivamente). Conclusão: Este estudo encontrou variabilidade entre as bases UpToDate®, Micromedex® e Whitebook® em relação às informações sobre ajuste posológico na insuficiência renal e sugere considerar mais de uma fonte para a tomada de decisões clínicas.

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“…More study is needed to determine the feasibility and outcomes of implementing a "tunneled HD catheter first" approach (14). When feasible and safe, tunneled HD catheter insertion should be considered over nontunneled HD catheter insertion if the need for intermittent HD is expected to be prolonged (3,15).…”

Section: Details Considerations Related Tomentioning

confidence: 99%

Management of Intermittent Hemodialysis in the Critically Ill Patient

Chan

Helmeczi

Canney

et al. 2023

CJASN

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Intermittent hemodialysis remains a cornerstone of extracorporeal KRT in the intensive care unit, either as a first-line therapy for AKI or a second-line therapy when patients transition from a continuous or prolonged intermittent therapy. Intermittent hemodialysis is usually provided 3 days per week in this setting on the basis that no clinical benefits have been demonstrated with more frequent hemodialysis. This should not detract from the importance of continually assessing and refining the hemodialysis prescription (including the need for extra treatments) according to dynamic changes in extracellular volume and other parameters, and ensuring that an adequate dose of hemodialysis is being delivered to the patient. Compared with other KRT modalities, the cardinal challenge encountered during intermittent hemodialysis is hemodynamic instability. This phenomenon occurs when reductions in intravascular volume, as a consequence of ultrafiltration and/or osmotic shifts, outpace compensatory plasma refilling from the extravascular space. Myocardial stunning, triggered by intermittent hemodialysis, and independent of ultrafiltration, may also contribute. The hemodynamic effect of intermittent hemodialysis is likely magnified in patients who are critically ill due to an inability to mount sufficient compensatory physiologic responses in the context of multiorgan dysfunction. Of the many interventions that have undergone testing to mitigate hemodynamic instability related to KRT, the best evidence exists for cooling the dialysate and raising the dialysate sodium concentration. Unfortunately, the evidence supporting routine use of these and other interventions is weak owing to poor study quality and limited sample sizes. Intermittent hemodialysis will continue to be an important and commonly used KRT modality for AKI in patients with critical illness, especially in jurisdictions where resources are limited. There is an urgent need to harmonize the definition of hemodynamic instability related to KRT in clinical trials and robustly test strategies to combat it in this vulnerable patient population.

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Prescribing Continuous Kidney Replacement Therapy in Acute Kidney Injury: A Narrative Review

Cited by 6 publications

References 73 publications

Safety and Feasibility of Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy With Calcium‐Containing Solutions: A Randomized Controlled Trial

Safety and Feasibility of Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy With Calcium‐Containing Solutions: A Randomized Controlled Trial

Ajuste posológico na insuficiência renal: comparação entre bases de dados

Management of Intermittent Hemodialysis in the Critically Ill Patient

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