Renal replacement therapy during extracorporeal membrane oxygenation

Subbarayan, Balasubramanian; Vivek, V.; Kuppuswamy, Madhan Kumar

doi:10.1007/s12055-019-00920-0

Cited by 4 publications

(7 citation statements)

References 24 publications

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“…A hybrid modality of RRT that combines advantages of both intermittent HD and CRRT is sustained low‐efficiency dialysis (SLED), which is a form of prolonged intermittent RRT (PIRRT). Using similar HD machines, SLED provides similar UF and clearance as HD but gradually, typically over 6–12 h, by using lower blood and dialysate flow rates 14 …”

Section: Overview Of Aki Treatment Modalitiesmentioning

confidence: 99%

“…Using similar HD machines, SLED provides similar UF and clearance as HD but gradually, typically over 6-12 h, by using lower blood and dialysate flow rates. 14 Regardless of specific CRRT modality, nutrition needs should account for anticipated losses in effluent. During CRRT, patient electrolytes equilibrate to the dialysate, which can vary by manufacturer but typically includes varying amounts of sodium, potassium, chloride, bicarbonate, lactate, magnesium, calcium, and glucose.…”

Section: Crrtmentioning

confidence: 99%

“…CVVHDF uses both dialysate and replacement fluids to optimize both convection and diffusive dialysis, allowing clearance of both small‐sized and medium‐sized molecules. CRRT can also be performed in patients during extracorporeal membrane oxygenation (ECMO) either with an in‐line hemofilter and dialysate to achieve CVVHD or with inclusion of a CRRT machine into the ECMO circuit, 14 allowing CVVHDF to be performed. A hybrid modality of RRT that combines advantages of both intermittent HD and CRRT is sustained low‐efficiency dialysis (SLED), which is a form of prolonged intermittent RRT (PIRRT).…”

Section: Overview Of Aki Treatment Modalitiesmentioning

confidence: 99%

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Nutrition for critically ill children and neonates requiring dialysis: Application of clinical practice recommendations

Wong Vega,

Vuong,

Chmielewski

et al. 2023

Nut in Clin Prac

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Approximately 30% of all children and neonates admitted to the intensive care unit (ICU) experience acute kidney injury (AKI). Children with AKI are largely poorly fed and experience high rates of malnutrition. Nutrition prescription and provision are exceptionally challenging for critically ill neonates, infants, and children with AKI given the dynamic nature of AKI and its respective treatment modalities. Managing the nutrition prescription of critically ill neonates, infants, and children with AKI requires nutrition support clinicians to have a high‐level understanding of the various treatment modalities for AKI, which can affect the patient's protein, fluid, electrolyte, and mineral needs. Accurate and timely nutrition assessment in critically ill neonates and children with AKI can be flawed owing to difficulty obtaining accurate anthropometric parameters. Recently, the Pediatric Renal Nutrition Taskforce introduced clinical practice recommendations for the nutrition management of children with AKI. In this review, we will discuss the practical implications of these recent guidelines and work to bridge the knowledge and practice gaps for pediatric and neonatal nutrition support clinicians providing nutrition therapy for patients with AKI in the ICU. We also appraise special nutrition‐related considerations for neonates with AKI given newer available renal replacement treatment modalities.

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Section: Overview Of Aki Treatment Modalitiesmentioning

confidence: 99%

Section: Crrtmentioning

confidence: 99%

Section: Overview Of Aki Treatment Modalitiesmentioning

confidence: 99%

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Nutrition for critically ill children and neonates requiring dialysis: Application of clinical practice recommendations

Wong Vega,

Vuong,

Chmielewski

et al. 2023

Nut in Clin Prac

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Section: Introductionmentioning

confidence: 99%

“…Reportedly, AKI is a common indication for approximately 42%–85% of patients receiving ECMO [ 2 — 4 ]. The pathogenesis and high frequency of AKI in ECMO patients are intrinsically complicated, owing to the underlying illness and other ECMO-related variables [ 4 , 5 ]. In these cases, continuous renal replacement therapy (CRRT) is increasingly being used for renal replacement and fluid management.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for mortality in surgical patients on combined continuous renal replacement therapy and extracorporeal membrane oxygenation: single-center retrospective study

Huang,

Wang,

Feng

et al. 2023

Renal Failure

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Objective In patients receiving extracorporeal membrane oxygenation (ECMO), continuous renal replacement therapy (CRRT) is increasingly being used for renal replacement and fluid management. However, critically ill surgical patients receiving combined ECMO and CRRT tend to have a high mortality rate, and there are limited studies on this population. Therefore, we aimed to investigate the risk factors for mortality in surgical patients receiving combined ECMO and CRRT. Methods Data of surgical patients who underwent ECMO between December 2013 and April 2023 were retrospectively reviewed. Univariate and multivariate logistic regression analysis were used to identify the risk variables. Receiver operating characteristic (ROC) curve analysis was used to determine the cutoff value of albumin and age to predict death. Results A total of 199 patients on ECMO support were screened, of which 105 patients were included in the final analysis. Of 105 patients, 77 (73.33%) were treated with CRRT. Veno-arterial ECMO was performed in 97 cases (92.38%), and the rest were veno-venous ECMO ( n = 8, 7.62%). Cardiovascular-related surgery was performed in the main patients ( n = 86, 81.90%) and other types of surgery in 19 patients. In surgical patients on ECMO support, the logistic regression analysis showed that CRRT implantation, male sex, and age were the independent risks factors for mortality. Furthermore, the ROC curve analysis showed that age 48.5 years had the highest Youden index. In surgical patients on combined CRRT and ECMO, age, valvular heart disease, and albumin were the independent risk factors for prognosis. Albumin had the highest Youden index at a cutoff value of 39.95 g/L for predicting mortality, though the overall predictive value was modest (area under ROC 0.704). Age had the highest Youden index at a cutoff value of 48.5 years for predicting mortality. Conclusions In our cohort of surgical patients requiring ECMO, which consisted mostly of patients undergoing cardiovascular surgery requiring VA-ECMO, the need for CRRT was an independent risk factor for mortality. In the subset of patients on combined CRRT and ECMO, independent risk factors for mortality included higher age, lack of valvular heart disease, and lower serum albumin.

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Optimizing the connection of CRRT and ECMO lines with additional pressure regulator on the therapeutic effect, filter life, and incidence of complications

Huang,

Gao,

Chen

et al. 2024

Medicine

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Background: Extracorporeal membrane oxygenation (ECMO) is used for severe cardiopulmonary failure, with veno-arterial ECMO for cardiogenic shock and veno-venous ECMO for acute respiratory failure. ECMO’s application has expanded to ICUs, emergency departments, and operating rooms. ECMO patients are at high risk for complications, including acute kidney injury (AKI), often requiring renal replacement therapy (RRT), posing significant management challenges. Methods: From August 2015 to June 2022, 120 patients were cured with veno-venous ECMO (n = 60) or veno-arterial ECMO (VA-ECMO, n = 60) combined with CRRT in our hospital. In the control group (n = 60), the input end (arterial end) of CRRT was connected to the ECMO oxygenator. The reinfusion end (venous end) of CRRT was connected to the oxygenator of ECMO for CRRT + ECMO treatment. In the experimental group (n = 60), the input end (arterial end) of CRRT was connected to the oxygenator of ECMO, and an additional pressure regulating device was installed on the connection of the 2 lines. The observation indexes including clinical therapeutic effect, clinical therapeutic effect, the incidence of complications, and the incidence of complications were compared. Results: There was a notable decrease in serum creatinine, and the differences in blood urea nitrogen, procalcitonin, and C-reactive protein after operation were statistically significant (P < .05). The filter use time in the study group was notably longer (P < .01). There exhibited no remarkable difference in the incidences of bleeding, thrombosis, numbness of hands and feet, metabolic alkalosis, disseminated intravascular coagulation, organ dysfunction syndrome, hyperbilirubinemia, and infection. Conclusion: This study demonstrates that additional pressure regulation devices are installed at the line connection between the CRRT input end and the CRRT return end to ensure that the flow rate of ECMO does not affect the CRRT treatment. ECMO and CRRT provide a safe pressure range so that the ECMO line can be safely connected to the CRRT machine at physiological pressure, reducing the occurrence of complications related to CRRT machine interruption and improving the efficiency of CRRT without affecting the efficiency of ECMO, ensuring patient safety.

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Renal replacement therapy during extracorporeal membrane oxygenation

Cited by 4 publications

References 24 publications

Nutrition for critically ill children and neonates requiring dialysis: Application of clinical practice recommendations

Nutrition for critically ill children and neonates requiring dialysis: Application of clinical practice recommendations

Risk factors for mortality in surgical patients on combined continuous renal replacement therapy and extracorporeal membrane oxygenation: single-center retrospective study

Optimizing the connection of CRRT and ECMO lines with additional pressure regulator on the therapeutic effect, filter life, and incidence of complications

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