Regional anticoagulation and antiaggregation for CVVH in critically ill patients: a prospective, randomized, controlled pilot study

Nucera, Maria; Malyan, M. Al; Becchi, C.

doi:10.1111/j.1399-6576.2009.02031.x

Cited by 18 publications

(24 citation statements)

References 15 publications

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“…A few small trials showed improved filter survival during CRRT when adding prostaglandins to heparin compared with heparin alone [95-97]. However, prostaglandins appear to have a limited efficacy when used alone, induce systemic hypotension [98,99], and are expensive.…”

Section: Recommendations and Rationalementioning

confidence: 99%

Contrast-induced acute kidney injury and renal support for acute kidney injury: a KDIGO summary (Part 2)

2013

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Acute kidney injury (AKI) is a common and serious problem affecting millions and causing death and disability for many. In 2012, Kidney Disease: Improving Global Outcomes completed the first ever international multidisciplinary clinical practice guideline for AKI. The guideline is based on evidence review and appraisal, and covers AKI definition, risk assessment, evaluation, prevention, and treatment. Two topics, contrast-induced AKI and management of renal replacement therapy, deserve special attention because of the frequency in which they are encountered and the availability of evidence. Recommendations are based on systematic reviews of relevant trials. Appraisal of the quality of the evidence and the strength of recommendations followed the Grading of Recommendations Assessment, Development and Evaluation approach. Limitations of the evidence are discussed and a detailed rationale for each recommendation is provided. This review is an abridged version of the guideline and provides additional rationale and commentary for those recommendation statements that most directly impact the practice of critical care.

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Section: Recommendations and Rationalementioning

confidence: 99%

Contrast-induced acute kidney injury and renal support for acute kidney injury: a KDIGO summary (Part 2)

2013

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“…Of these, 157 were excluded on the basis of titles and abstracts, because they were reviews, observational studies, retrospective studies, case reports, and other irrelevant studies. Of the remaining 10 articles, four were excluded after assessment of the full-text article, because two were nonrandomized sequential trials [8,11], one used regional heparin anticoagulation as the treatment group [12], and one allocated patients to the citrate group because they had contraindications for systemic heparin administration [13]. As a result, a total of six studies [14][15][16][17][18][19] were finally included into the meta-analysis (Fig.…”

Section: Study Enrollment and Characteristicsmentioning

confidence: 99%

Efficacy and safety of regional citrate anticoagulation in critically ill patients undergoing continuous renal replacement therapy

Zhang

2011

Intensive Care Med

141

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RCA is effective in maintaining circuit patency and reducing the risk of bleeding, and thus can be recommended for CRRT if and when metabolic monitoring is adequate and the protocol is followed. However, the safety of citrate in patients with liver failure cannot be concluded from current analysis. The metabolic stability can be easily controlled during RCA. Survival benefit from RCA is still controversial due to limited evidence.

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“…One such study compared the use of pre-filter heparin and prostacyclin with post-filter protamine sulfate versus pre-filter heparin alone in CVVH. The filter transmembrane pressure rise was used to detect filter clotting, a significant rise of which was seen in the group on heparin anticoagulation alone [8]. A study of pre- versus post-dialyzer pressure differences in intermittent hemodialysis concluded that such differences could not significantly unmask subclinical clotting resulting in inefficient hemodialysis [12].…”

Section: Discussionmentioning

confidence: 99%

“…Most modern CRRT machines are equipped with pressure sensors, and many studies allude to their reliance on pressure readings to prompt interventions such as change of circuit. The transmembrane pressure has been used to diagnose clotting when comparing two anticoagulation methods during continuous venovenous hemofiltration (CVVH) [8]. Similar studies also adopted extracorporeal line pressure readings rising above 250 mm Hg as an acceptable surrogate for hemofilter clotting [9].…”

Section: Introductionmentioning

confidence: 99%

Real-Time Circuit Pressures Correlate Poorly with Circuit Longevity in Anticoagulant-Free, Predilution Continuous Venovenous Hemofiltration

Tan

Choong

2011

Blood Purif

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Background: Continuous venovenous hemofiltration (CVVH) in renal failure is compromised by circuit clotting. We hypothesized that adverse circuit pressures are predictive of clotting in circuits that last less than 24 h during predilution, anticoagulant-free CVVH. Methods: This was a single-center retrospective study of 63 CVVH circuits of 13 critically ill intensive care unit patients with severe renal failure. Circuits were categorized into ‘clotters’ (C) or ‘nonclotters’ (NC), if spontaneous clotting occurred at <24 or ≧24 h from the start of CVVH, respectively. Results: Effluent pressures and pre-filter pressures were more adverse in NC compared to C starting from 6 and 4 h before spontaneous clotting, respectively. Arterial pressures and return pressures were not significantly different in C versus NC. Blood flow rate settings, hemofiltration fluid replacement and effluent drainage rates in C versus NC were comparable. Conclusion: Real-time circuit pressure readings seem to offer only potentially limited prognostic value in predicting circuit clotting.

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Regional anticoagulation and antiaggregation for CVVH in critically ill patients: a prospective, randomized, controlled pilot study

Cited by 18 publications

References 15 publications

Contrast-induced acute kidney injury and renal support for acute kidney injury: a KDIGO summary (Part 2)

Contrast-induced acute kidney injury and renal support for acute kidney injury: a KDIGO summary (Part 2)

Efficacy and safety of regional citrate anticoagulation in critically ill patients undergoing continuous renal replacement therapy

Real-Time Circuit Pressures Correlate Poorly with Circuit Longevity in Anticoagulant-Free, Predilution Continuous Venovenous Hemofiltration

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