Hypernatremia is one of the commonly syndromes in critically ill patients. Severe hypernatremia has a low incidence (0.6%–1.0%) but with a very high mortality (58%–87%). Conventional treatments include the limitation of sodium intake and the supplement of sodium free liquid according to the assessed water lost. The reduction rates of conventional treatments are commonly not effective enough to decrease the serum sodium concentration in severe euvolemic or hypervolemic hypernatremia patients. Continuous renal replacement therapy (CRRT) has been reported to be effective on the reduction of sodium level in severe hypernatremia patients. However, the evidences on the use of CRRT for hypernatremia are limited. Our present review summarizes the current evidences on the prevalence of hypernatremia, the outcome of hypernatremia patients, the conventional treatment of hypernatremia, and the advantages and indications of CRRT for the management of hypernatremia. Additionally, we introduce our experiences on the management of hypernatremia using CRRT as well.
Because existing anticoagulants may have contraindications and side effects, continuous renal replacement therapy (CRRT) without anticoagulants is nevertheless widely used. Although it does not produce major adverse effects without anticoagulant CRRT, it can raise the risk of clotting, which can lead to treatment cessation. Extracorporeal circulation lines with saline flush are frequently utilized as a non-pharmaceutical anticoagulation strategy. However, in the absence of anticoagulant CRRT, its clinical efficacy remains debatable. Therefore, this article reviews the specific procedures, flushing frequency, flushing effect, and adverse events of flushing extracorporeal circulation lines with normal saline when CRRT is free anticoagulant, generating fresh ideas for future research.
Continuous renal replacement therapy (CRRT) is one of the major treatments for critically ill patients. With the development of information technology, the informatization and artificial intelligent of CRRT has received wide attention, which has promoted the optimization of CRRT in terms of workflow, teaching method as well as scientific research. Benefiting from the big data generated, artificial intelligence is expected to be applied in the precision treatment, quality control, timing of intervention, as well as prognosis assessment in severe AKI, so as to ultimately improve the therapeutic effect of CRRT among critically ill patients. This paper summarizes the information construction of CRRT and the research progress of artificial intelligence, which can be used as a reference for practitioners in kidney disease, critical medicine, emergency medicine and other related fields.
Severe acute kidney injury usually requires renal replacement therapy. Intermittent hemodialysis, peritoneal dialysis, continuous renal replacement therapy, and prolonged intermittent renal replacement therapy are the four common modalities of renal replacement therapy. Whether one modality of renal replacement therapy is superior to another in clinical practice remains controversial. The impact of the choice of renal replacement therapy modality on the short-term and long-term prognosis of patients needs to be further explored in large-scale randomized controlled studies and a longer follow-up time. This article will discuss the development history of renal replacement therapy for acute kidney injury, the current status of its application, and the comparison of the four treatment modalities, in order to help clinicians have a deeper understanding of how to design individualized renal replacement therapy programs for patients with acute kidney injury under the guidance of the concept of precision medicine.
This article reviews Chinese nomenclature of renal replacement therapy and extracorporeal blood purification currently utilized to manage acute kidney injury and other organ dysfunction syndromes in critically ill patients, based on the recent reports of a consensus expert conference of Nomenclature Standardization Initiative Alliance. We provide a detailed description of the performance characteristics of membranes, filters, transmembrane transport of solutes and fluid, flows, and methods of measurement of delivered treatment, common definitions, components, techniques, and operations of the machines and platforms as well as the renal replacement therapy techniques in detail with the relevant technologies, procedures, operations, and recent developments in other extracorporeal therapies, including therapeutic plasma exchange, multiple organ support therapy, liver support, lung support, and blood purification in sepsis. We believe this nomenclature review will serve future use of terminology in publications, research, clinical operations and therapy platforms to enable consistent data collection and comparison.
Continuous renal replacement therapy (CRRT) originated from intermittent hemodialysis. Over the past 40 years, its application scope has gradually expanded from the initial treatment of kidney diseases alone to the support of multi-organ functions. As a safe, adequate, and flexible therapeutic modality, CRRT has become one of the main means of treating critically ill patients. Continuous innovation in technology, biomaterials and other technologies provides important driving force for the sustainable development of CRRT. This paper reviews the technological innovation and development of CRRT devices. With continuous technological updates and iteration, CRRT can better adapt to clinical needs. Biofeedback, portability, and intelligence are several directions of the development of CRRT, which can provide more accurate and personalized treatment for critically ill patients in different scenarios.
Objective To evaluate the efficacy and safety of nafamostat mesylate as an in vitro anticoagulant in continuous renal replacement therapy (CRRT) using oXiris filters for patients with sepsis-associated acute kidney injury (SA-AKI). Methods SA-AKI patients at high risk of bleeding who received oXiris filter-CRRT at West China Hospital of Sichuan University between November 2021 and January 2023 were included in the study. Patients who received nafamostat mesylate as an anticoagulant were categorized into the nafamostat group, while patients who did not receive any anticoagulant during the same period were categorized into the control group. A comparative analysis was conducted between the two groups regarding general conditions, the lifespan of the first filter in CRRT, the number and percentage of cases with the first filter lasting 24, 48, and 72 h, activated clotting time (ACT) before and during treatment (both pre-filter and post-filter), laboratory test results before and after treatment, incidence of adverse reactions during treatment, and clinical outcomes of the patients. The mean ± standard deviation was used for normal distribution, and the median (lower quartile, upper quartile) was used for non-normal distribution. Results A total of 118 patients were included in the study, with 90 in the control group and 28 in the nafamostat group. There was no statistically significant difference in the general conditions or pre-treatment laboratory test indicators between the two groups (P>0.05). Kaplan-Meier survival analysis showed that the lifespan of the first filter was longer in the nafamostat group compared to the control group (hazard ratio=0.524, P=0.001). The percentage of patients whose first filter lasted 24 h was higher in the nafamostat group than that in the control group (60.7% vs. 25.7%, P=0.001); however, there was no statistically significant difference between the two groups for the first filter lasting 48 h or 72 h (P>0.05). During CRRT treatment, the mean post-filter ACT was longer in the nafamostat group than that in the control group [(216.7±43.2) vs. (181.6±35.5) s, P<0.001], and the mean post-filter ACT was longer than the pre-filter ACT in the nafamostat group [(216.7±43.2) vs. (183.3±37.7) s, P=0.005]. After the treatment, the international normalized ratio [1.5 (1.1, 1.8) vs. 1.7 (1.4, 2.4)], interleukin-6 levels [(235.5±80.9) vs. (500.5±112.7) pg/mL] were lower, and platelet count [48.0 (31.8, 73.0)×109/L vs. 29.0 (11.0, 61.8)×109/L] was higher in the nafamostat group compared to the control group (P<0.05). There was no statistically significant difference in other laboratory test indicators (P>0.05). The clinical outcomes of the patients did not show statistically significant difference between the two groups (P>0.05). Conclusion Nafamostat mesilate may be an effective and safe anticoagulant in SA-AKI patients at high risk of bleeding underwent oXiris filter-CRRT, and its in vitro anticoagulant effect is better than that without anticoagulant.
Acute kidney injury (AKI) is common in hospitalized individuals, associated with adverse outcomes and increased cost. Continuous renal replacement therapy (CRRT) is used to treat critically ill patients with AKI, of which the cost in acute phase is higher than that of intermittent renal replacement therapy (IRRT). However, if treatment for subsequent chronic kidney disease or dialysis dependency following AKI is also considered, CRRT might be more cost-effective than IRRT. In this editorial, the cost and health economic evaluation of CRRT for critically ill patients is discussed.
ObjectiveTo explore the feasibility of pipeline blood sampling test of continuous renal replacement therapy (CRRT) when arteriovenous reversal connection occurs, and to explore the influence of pipeline blood sampling test on the results of CRRT when arteriovenous reversal connection occurs under different anticoagulation methods.MethodsSelected patients with arteriovenous reversals treated by CRRT in a third-class A hospital was selected from June 2018 to May 2019. Blood samples were collected from the front end of the CRRT pipeline (0-, 3-, and 5-min after the cease). Blood samples collected from the catheterization site were compared with those from the body vein for acid and alkali, respectively. The electrolyte and other results were analyzed and compared.ResultsA total of 80 patients were enrolled, including 40 with low molecular weight heparin and non-heparin, and 40 with citric acid. Under the anticoagulation condition of low molecular weight heparin and non-heparin, there was no difference in acid-base or electrolyte between body venous blood samples and pipeline blood samples (P>0.05). Under the anticoagulation condition of citric acid, 0-, 3-, and 5-min after the cease, the difference in free calcium between body venous blood samples and pipeline blood samples was significant (F=7.866, 6.691, 5.590, P<0.001). There was no difference in other acid-base or electrolyte results (P>0.05).ConclusionsLow molecular weight heparin and heparin-free anticoagulation can be tested by collecting blood samples from the front end of the pipeline without suspension of treatment in the case of arteriovenous reversal in CRRT. There was a difference between free calcium and body venous blood in anticoagulation with citric acid. It is not recommended to collect blood from pipes for examination Under the anticoagulationcondition of citric acid.