Acute Renal Replacement Therapies in Critically Ill Patients
Journal: Advances in Medicine and Engineering Interdisciplinary Research DOI: 10.32629/ameir.v2i2.2016
Abstract
Acute kidney injury (AKI) is defined as the abrupt deterioration of renal excretory function, often observed in critically ill patients. The incidence of AKI worldwide ranges between 20 and 200 cases per million population. Sepsis and septic shock contribute to 25-75% of AKI cases. Regardless of the cause, loss of fluid and electrolyte homeostasis and the accumulation of nitrogenous wastes lead to uremia, hyperkalemia, water and sodium retention, and metabolic acidosis. Renal replacement therapies (RRT) aim to mitigate these effects and prevent death associated with kidney failure. There are various modalities of RRT, including intermittent hemodialysis, continuous RRT, as well as different solute elimination techniques. There have been significant advances in membrane technologies and the addition of substances to improve biocompatibility, in addition to new anticoagulation strategies. The aim of this article is to review current RRT alternatives and comment on recommendations regarding their dosage and timing for starting and discontinuing therapy.
Keywords
renal replacement therapy; acute kidney injury; hybrid renal replacement therapy
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[21] Nash DM, Przech S, Wald R, O'Reilly D. Systematic review and metaanalysis of renal replacement therapy modalities for acute kidney injury in the intensive care unit. J Crit Care. 2017;41:138-144. doi: 10.1016/j.jcrc.2017.05.002
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[23] Davenport A. Practical guidance for dialyzing a hemodialysis patient following acute brain injury. Hemodial Int. 2008;12(3):307-312. doi: 10.1111/j.1542-4758.2008.00271.x
[24] Burton JO, Jefferies HJ, Selby NM, McIntyre CW. Hemodialysisinduced repetitive myocardial injury results in global and segmental reduction in systolic cardiac function. Clin J Am Soc Nephrol. 2009;4(12):1925-1931. doi: 10.2215/CJN.04470709
[25] Canaud B, Kooman JP, Selby NM, et al. Dialysis-induced cardiovascular and multiorgan morbidity. Kidney Int Rep. 2020;5(11):1856-1869.
[26] Beaubien-Souligny W, Yang Y, Burns KEA, Friedrich JO, Meraz-Muñoz A, Clark EG, et al. Intra-dialytic hypotension following the transition from continuous to intermittent renal replacement therapy. Ann Intensive Care. 2021;11(1):96. doi: 10.1186/s13613-021-00885-7
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[31] Junhai Z, Beibei C, Jing Y, Li L. Effect of high-volume hemofiltration in critically ill patients: a systematic review and meta-analysis. Med Sci Monit. 2019;25:3964-3975. doi: 10.12659/MSM.916767
[32] Ronco C. Evolution of hemodiafiltration. Contrib Nephrol. 2007;158:9-19. doi: 10.1159/000107230
[33] Cheah WK, Ishikawa K, Othman R, Yeoh FY. Nanoporous biomaterials for uremic toxin adsorption in artificial kidney systems: A review. J Biomed Mater Res B Appl Biomater. 2017;105(5):1232-1240. doi: 10.1002/jbm.b.33475
[34] Lu L. New Membrane Technologies for Dialysis. University of Waterloo: Waterloo, ON, Canada, 2016.
[35] Pescatore NA. Graphitic Carbon Materials Tailored for the Rapid Adsorption of Biomolecules. Drexel University: Philadelphia, PA,USA, 2016.
[36] Mehta Y, Mehta C, Kumar A, George JV, Gupta A, Nanda S, et al. Experience with hemoadsorption (CytoSorb®) in the management of septic shock patients. World J Crit Care Med. 2020;9(1):1-12. doi: 10.5492/wjccm.v9.i1.1
[37] CytoSorb®. The Adsorber-CytoSorbents Europe GmbH. Disponible: https://cytosorb-therapy.com/en/the-adsorber/
[38] Cruz DN, Antonelli M, Fumagalli R, Foltran F, Brienza N, Donati A, et al. Early use of polymyxin B hemoperfusion in abdominal septic shock: the EUPHAS randomized controlled trial. JAMA. 2009;301(23):2445-2452. doi: 10.1001/jama.2009.856
[39] Shum HP, Chan KC, Kwan MC, Yan WW. Application of endotoxin and cytokine adsorption haemofilter in septic acute kidney injury due to Gram-negative bacterial infection. Hong Kong Med J. 2013;19(6):491-497. doi: 10.12809/hkmj133910
[40] Zarbock A, Kellum JA, Schmidt C, Van Aken H, Wempe C, Pavenstädt H, et al. Effect of early vs delayed initiation of renal replacement therapy on mortality in critically ill patients with acute kidney injury: the elain randomized clinical trial. JAMA. 2016;315(20):2190- 2199. doi: 10.1001/jama.2016.5828
[41] Gaudry S, Hajage D, Martin-Lefevre L, Lebbah S, Louis G, Moschietto S, et al. Comparison of two delayed strategies for renal replacement therapy initiation for severe acute kidney injury (AKIKI 2): a multicentre, open-label, randomised, controlled trial. Lancet. 2021;397(10281):1293-1300. doi: 10.1016/S0140- 6736(21)00350-0
[42] Barbar SD, Clere-Jehl R, Bourredjem A, Hernu R, Montini F, Bruyère R, et al.; IDEAL-ICU Trial Investigators and the CRICS TRIGGERSEP Network. Timing of renal-replacement therapy in patients with acute kidney injury and sepsis. N Engl J Med. 2018;379(15):1431- 1442. doi: 10.1056/NEJMoa1803213
[43] VA/NIH Acute Renal Failure Trial Network; Palevsky PM, Zhang JH, O'Connor TZ, Chertow GM, Crowley ST, et al. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008;359(1):7-20. doi: 10.1056/NEJMoa0802639 Erratum in: N Engl J Med. 2009;361(24):2391.
[44] RENAL Replacement Therapy Study Investigators; Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, et al. Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med. 2009;361(17):1627-1638. doi: 10.1056/NEJMoa0902413
[45] Jones SL, Devonald MA. How acute kidney injury is investigated and managed in UK intensive care units--a survey of current practice. Nephrol Dial Transplant. 2013;28(5):1186-1190. doi: 10.1093/ndt/gft015
[46] Uchino S, Bellomo R, Morimatsu H, Morgera S, Schetz M, Tan I, et al. Discontinuation of continuous renal replacement therapy: a post hoc analysis of a prospective multicenter observational study. Crit Care Med. 2009;37(9):2576-2582. doi: 10.1097/ CCM.0b013e3181a38241
[47] Wu VC, Ko WJ, Chang HW, Chen YW, Lin YF, Shiao CC, et al.; National Taiwan University Surgical ICU Acute Renal Failure Study Group (NSARF). Risk factors of early redialysis after weaning from postoperative acute renal replacement therapy. Intensive Care Med. 2008;34(1):101-108. doi: 10.1007/s00134-007-0813-x
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[2] Chu R, Li C, Wang S, Zou W, Liu G, Yang L. Assessment of KDIGO definitions in patients with histopathologic evidence of acute renal disease. Clin J Am Soc Nephrol. 2014;9(7):1175-1182. doi: 10.2215/CJN.06150613
[3] Hsu CY, McCulloch CE, Fan D, Ordoñez JD, Chertow GM, Go AS. Community-based incidence of acute renal failure. Kidney Int. 2007;72(2):208-212. doi: 10.1038/sj.ki.5002297
[4] Chawla LS, Bellomo R, Bihorac A, Goldstein SL, Siew ED, Bagshaw SM, et al; Acute Disease Quality Initiative Workgroup 16. Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup. Nat Rev Nephrol. 2017;13(4):241-257. doi: 10.1038/nrneph.2017.2
[5] Zarbock A, Nadim MK, Pickkers P, Gomez H, Bell S, Joannidis M, et al. Sepsis-associated acute kidney injury: consensus report of the 28th Acute Disease Quality Initiative workgroup. Nat Rev Nephrol. 2023;19(6):401-417. doi: 10.1038/s41581-023-00683-3
[6] Vodovar D, Mégarbane B. Extracorporeal kidney-replacement therapy for acute kidney injury. N Engl J Med. 2022;386(23):2250. doi: 10.1056/NEJMc2204453
[7] McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med. 2003;348(12):1123-1133. doi: 10.1056/NEJMra011883
[8] Parienti JJ, Thirion M, Mégarbane B, Souweine B, Ouchikhe A, Polito A, et al.; Members of the Cathedia Study Group. Femoral vs jugular venous catheterization and risk of nosocomial events in adults requiring acute renal replacement therapy: a randomized controlled trial. JAMA. 2008;299(20):2413-2422. doi: 10.1001/jama.299.20.2413
[9] O'Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, et al. Guidelines for the prevention of intravascular catheterrelated infections. Centers for Disease Control and Prevention. MMWR Recomm Rep. 2002;51(RR-10):1-29.
[10] Glorieux G, Tattersall J. Uraemic toxins and new methods to control their accumulation: game changers for the concept of dialysis adequacy. Clin Kidney J. 2015;8(4):353-362. doi: 10.1093/ckj/sfv034
[11] Gautham A, Muhammed JM, Manavalan M, Najeb M. A hemodialysis membranes: past, present and future trends. Int. Res. J. Pharm. 2013;4:16-19. doi: 10.7897/2230-8407.04505
[12] Sakai K. Determination of pore size and pore size distribution: 2. dialysis membrane. J. Memb. Sci. 1994; 96:91-130. doi:10.1016/0376-7388(94)00127-8
[13] Ronco C, Cruz DN. Hemodialysis - From Basic Research to Clinical Trials. Karger: Basel, Switzerland, 2008.
[14] Zarbock A, Küllmar M, Kindgen-Milles D, Wempe C, Gerss J, Brandenburger T, et al.; RICH Investigators and the Sepnet Trial Group. Effect of regional citrate anticoagulation vs systemic heparin anticoagulation during continuous kidney replacement therapy on dialysis filter life span and mortality among critically ill patients with acute kidney injury: a randomized clinical trial. JAMA. 2020;324(16):1629-1639. doi: 10.1001/jama.2020.18618
[15] Kaewdoungtien P, Tachaboon S, Kangsumrith N, Srisawat N. Immunomodulation effect of regional citrate anticoagulation in acute kidney injury requiring renal replacement therapy. Blood Purif. 2023;52(5):474-482. doi: 10.1159/000529350
[16] Raharjo Y, Zainol Abidin MN, Ismail AF, Fahmi MZ, Saiful, Elma M, et al. Dialysis membranes for acute kidney injury. Membranes (Basel). 2022;12(3):325. doi: 10.3390/membranes12030325
[17] Vinsonneau C, Camus C, Combes A, Costa de Beauregard MA, Klouche K, Boulain T, et al.; Hemodiafe Study Group. Continuous venovenous haemodiafiltration versus intermittent haemodialysis for acute renal failure in patients with multiple-organ dysfunction syndrome: a multicentre randomised trial. Lancet. 2006;368(9533):379-385. doi: 10.1016/S0140-6736(06)69111-3
[18] Rabindranath K, Adams J, Macleod AM, Muirhead N. Intermittent versus continuous renal replacement therapy for acute renal failure in adults. Cochrane Database Syst Rev. 2007;(3):CD003773. doi: 10.1002/14651858.CD003773.pub3
[19] Bagshaw SM, Berthiaume LR, Delaney A, Bellomo R. Continuous versus intermittent renal replacement therapy for critically ill patients with acute kidney injury: a meta-analysis. Crit Care Med. 2008;36(2):610-617. doi: 10.1097/01. CCM.0B013E3181611F552
[20] Pannu N, Klarenbach S, Wiebe N, Manns B, Tonelli M; Alberta Kidney Disease Network. Renal replacement therapy in patients with acute renal failure: a systematic review. JAMA. 2008;299(7):793-805. doi: 10.1001/jama.299.7.793
[21] Nash DM, Przech S, Wald R, O'Reilly D. Systematic review and metaanalysis of renal replacement therapy modalities for acute kidney injury in the intensive care unit. J Crit Care. 2017;41:138-144. doi: 10.1016/j.jcrc.2017.05.002
[22] Lin CM, Lin JW, Tsai JT, Ko CP, Hung KS, Hung CC, et al. Intracranial pressure fluctuation during hemodialysis in renal failure patients with intracranial hemorrhage. Acta Neurochir Suppl. 2008;101:141-4. doi: 10.1007/978-3-211-78205-7_24
[23] Davenport A. Practical guidance for dialyzing a hemodialysis patient following acute brain injury. Hemodial Int. 2008;12(3):307-312. doi: 10.1111/j.1542-4758.2008.00271.x
[24] Burton JO, Jefferies HJ, Selby NM, McIntyre CW. Hemodialysisinduced repetitive myocardial injury results in global and segmental reduction in systolic cardiac function. Clin J Am Soc Nephrol. 2009;4(12):1925-1931. doi: 10.2215/CJN.04470709
[25] Canaud B, Kooman JP, Selby NM, et al. Dialysis-induced cardiovascular and multiorgan morbidity. Kidney Int Rep. 2020;5(11):1856-1869.
[26] Beaubien-Souligny W, Yang Y, Burns KEA, Friedrich JO, Meraz-Muñoz A, Clark EG, et al. Intra-dialytic hypotension following the transition from continuous to intermittent renal replacement therapy. Ann Intensive Care. 2021;11(1):96. doi: 10.1186/s13613-021-00885-7
[27] Lee K, Jeong JH, Mun CH, Lee SR, Yoo KJ, Park YW, et al. Convectionenhanced high-flux hemodialysis. Artif Organs. 2007;31(8):653-658. doi: 10.1111/j.1525-1594.2007.00436.x
[28] Ficheux A, Ronco C, Brunet P, Argilés À. The ultrafiltration coefficient: this old ‘grand inconnu' in dialysis. Nephrol Dial Transplant. 2015;30(2):204-208. doi: 10.1093/ndt/gft493
[29] Honoré PM, Jacobs R, Boer W, Joannes-Boyau O, De Regt J, De Waele E, et al. New insights regarding rationale, therapeutic target and dose of hemofiltration and hybrid therapies in septic acute kidney injury. Blood Purif. 2012;33(1-3):44-51. doi: 10.1159/000333837
[30] Joannes-Boyau O, Honoré PM, Perez P, Bagshaw SM, Grand H, Canivet JL, et al. High-volume versus standard-volume haemofiltration for septic shock patients with acute kidney injury (IVOIRE study): a multicentre randomized controlled trial. Intensive Care Med. 2013;39(9):1535-1546. doi: 10.1007/s00134-013-2967-z
[31] Junhai Z, Beibei C, Jing Y, Li L. Effect of high-volume hemofiltration in critically ill patients: a systematic review and meta-analysis. Med Sci Monit. 2019;25:3964-3975. doi: 10.12659/MSM.916767
[32] Ronco C. Evolution of hemodiafiltration. Contrib Nephrol. 2007;158:9-19. doi: 10.1159/000107230
[33] Cheah WK, Ishikawa K, Othman R, Yeoh FY. Nanoporous biomaterials for uremic toxin adsorption in artificial kidney systems: A review. J Biomed Mater Res B Appl Biomater. 2017;105(5):1232-1240. doi: 10.1002/jbm.b.33475
[34] Lu L. New Membrane Technologies for Dialysis. University of Waterloo: Waterloo, ON, Canada, 2016.
[35] Pescatore NA. Graphitic Carbon Materials Tailored for the Rapid Adsorption of Biomolecules. Drexel University: Philadelphia, PA,USA, 2016.
[36] Mehta Y, Mehta C, Kumar A, George JV, Gupta A, Nanda S, et al. Experience with hemoadsorption (CytoSorb®) in the management of septic shock patients. World J Crit Care Med. 2020;9(1):1-12. doi: 10.5492/wjccm.v9.i1.1
[37] CytoSorb®. The Adsorber-CytoSorbents Europe GmbH. Disponible: https://cytosorb-therapy.com/en/the-adsorber/
[38] Cruz DN, Antonelli M, Fumagalli R, Foltran F, Brienza N, Donati A, et al. Early use of polymyxin B hemoperfusion in abdominal septic shock: the EUPHAS randomized controlled trial. JAMA. 2009;301(23):2445-2452. doi: 10.1001/jama.2009.856
[39] Shum HP, Chan KC, Kwan MC, Yan WW. Application of endotoxin and cytokine adsorption haemofilter in septic acute kidney injury due to Gram-negative bacterial infection. Hong Kong Med J. 2013;19(6):491-497. doi: 10.12809/hkmj133910
[40] Zarbock A, Kellum JA, Schmidt C, Van Aken H, Wempe C, Pavenstädt H, et al. Effect of early vs delayed initiation of renal replacement therapy on mortality in critically ill patients with acute kidney injury: the elain randomized clinical trial. JAMA. 2016;315(20):2190- 2199. doi: 10.1001/jama.2016.5828
[41] Gaudry S, Hajage D, Martin-Lefevre L, Lebbah S, Louis G, Moschietto S, et al. Comparison of two delayed strategies for renal replacement therapy initiation for severe acute kidney injury (AKIKI 2): a multicentre, open-label, randomised, controlled trial. Lancet. 2021;397(10281):1293-1300. doi: 10.1016/S0140- 6736(21)00350-0
[42] Barbar SD, Clere-Jehl R, Bourredjem A, Hernu R, Montini F, Bruyère R, et al.; IDEAL-ICU Trial Investigators and the CRICS TRIGGERSEP Network. Timing of renal-replacement therapy in patients with acute kidney injury and sepsis. N Engl J Med. 2018;379(15):1431- 1442. doi: 10.1056/NEJMoa1803213
[43] VA/NIH Acute Renal Failure Trial Network; Palevsky PM, Zhang JH, O'Connor TZ, Chertow GM, Crowley ST, et al. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008;359(1):7-20. doi: 10.1056/NEJMoa0802639 Erratum in: N Engl J Med. 2009;361(24):2391.
[44] RENAL Replacement Therapy Study Investigators; Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, et al. Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med. 2009;361(17):1627-1638. doi: 10.1056/NEJMoa0902413
[45] Jones SL, Devonald MA. How acute kidney injury is investigated and managed in UK intensive care units--a survey of current practice. Nephrol Dial Transplant. 2013;28(5):1186-1190. doi: 10.1093/ndt/gft015
[46] Uchino S, Bellomo R, Morimatsu H, Morgera S, Schetz M, Tan I, et al. Discontinuation of continuous renal replacement therapy: a post hoc analysis of a prospective multicenter observational study. Crit Care Med. 2009;37(9):2576-2582. doi: 10.1097/ CCM.0b013e3181a38241
[47] Wu VC, Ko WJ, Chang HW, Chen YW, Lin YF, Shiao CC, et al.; National Taiwan University Surgical ICU Acute Renal Failure Study Group (NSARF). Risk factors of early redialysis after weaning from postoperative acute renal replacement therapy. Intensive Care Med. 2008;34(1):101-108. doi: 10.1007/s00134-007-0813-x
[48] Fröhlich S, Donnelly A, Solymos O, Conlon N. Use of 2-hour creatinine clearance to guide cessation of continuous renal replacement therapy. J Crit Care. 2012;27(6):744.e1-744.e5. doi: 10.1016/j.jcrc.2012.08.012
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