Continuous veno-venous hemofiltration yields better renal outcomes than intermittent hemodialysis among traumatic intracranial hemorrhage patients with acute kidney injury: A nationwide population-based retrospective study in Taiwan

Tseng, Min Feng; Chou, Chu Lin; Chung, Chi Hsiang; Chien, Wu Chien; Chen, Ying Kai; Yang, Hsiu Chien; Liao, Chen; Wei, Kuang Yu; Wu, Chia Chao

doi:10.1371/journal.pone.0203088

Cited by 4 publications

(8 citation statements)

References 38 publications

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“…Fourth, in the case of CVVH, the standardized hypertonic drugs can be used to reduce both cerebral edema and intracranial pressure based on fluid balance control. 34,35 Fifth, the CVVH mode can also control and regulate the patient's body temperature, remove inflammatory mediators, and alleviate any secondary brain injury after acute brain injury. Prior studies have shown that the incidence of HAP among ICU patients with acute spontaneous ICH is as high as 60%.…”

Section: Discussionmentioning

confidence: 99%

“…Third, CVVH can better control the fluid balance so as not to cause fluid overload or aggravate cerebral edema. Fourth, in the case of CVVH, the standardized hypertonic drugs can be used to reduce both cerebral edema and intracranial pressure based on fluid balance control 34,35 . Fifth, the CVVH mode can also control and regulate the patient's body temperature, remove inflammatory mediators, and alleviate any secondary brain injury after acute brain injury 36 …”

Section: Discussionmentioning

confidence: 99%

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Efficacy of two hemodialyses in patients with chronic renal failure complicated by massive intracerebral hemorrhage

Zhu

Han

Xia

et al. 2023

Ann Clin Transl Neurol

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Objective To compare the efficacy of intermittent hemodialysis (IHD) and continuous veno‐venous hemofiltration (CVVH) in patients with chronic renal failure complicated by massive intracerebral hemorrhage. Methods Sixty‐two patients were randomly and equally divided into IHD and CVVH groups. The clinical variables were compared, including National Institutes of Health Stroke Scale (NIHSS) score as the primary indicator, cerebral edema volume, hospital‐acquired pneumonia (HAP) incidence, acute heart failure (AHF) incidence, rehemorrhage incidence, hospital stay length, and modified Rankin Scale (mRS) score. Results The CVVH group had lower NIHSS scores and edema volumes than the IHD group on postoperative days 7 and 14. Moreover, in the CVVH group, (i) the NIHSS scores on postoperative days 3 and 7 were higher than those on postoperative day 1; (ii) there was no significant difference in NIHSS scores between days 14 and 1; and (iii) no significant difference in cerebral edema volume was found between postoperative days 1 and 3, 7, and 14. In the IHD group, the NIHSS scores and cerebral edema volume on postoperative days 7 and 14 were significantly higher than those on postoperative day 1. The CVVH group had a lower incidence of HAP, AHF, and adverse events and shorter hospital stay length than the IHD group. The proportions of patients with mRS scores of 1 and 2 in the CVVH group were higher than those in the IHD group on day 30 after discharge. Interpretation CVVH is more effective than IHD in the treatment of patients with chronic renal failure complicated by massive intracerebral hemorrhage.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Efficacy of two hemodialyses in patients with chronic renal failure complicated by massive intracerebral hemorrhage

Zhu

Han

Xia

et al. 2023

Ann Clin Transl Neurol

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“…Several studies have suggested that strategies for starting RRT early (2 -7.6 hours after randomization) vs late (31 -57 hours after randomization) do not differ significantly in mortality or RRT -free days in critical units; however, neurocritical patients were not included in these studies (30)(31)(32)(33). Some trials recommend early start to ameliorate the osmotic effect of cytokines, nonetheless, the majority of published data includes AKI patients with classical indications for CRRT (20). Some animal models postulate that CVVH even without AKI may result of benefit in ABI (34).…”

Section: Discussionmentioning

confidence: 99%

“…Main indication of CRRT is to correct acidosis and inflammatory mediators present in AKI. There is still controversy regarding the modality of CRRT and optimal timing of initiating interventions for survival benefit (20)(21)(22). Discontinuation of CRRT initiates when renal function is reestablished.…”

Section: Role Of Nephrology Interventions In Abimentioning

confidence: 99%

Continuous Renal Replacement Therapy in Acute Brain Injury

Cruz-Llanos¹,

Molano

Rizo-Topete

2022

Front. Nephrol.

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Acute brain injury is the sudden and reversible loss of brain self regulation capacity as a disruption of the blood-brain barrier that conditions metabolic and inflammatory disorders that can exacerbate acute kidney injury in a critical setting; specifically it has been described that the alterations of the internal environment that come from the severity of the acute kidney injury increases the risk of endocranial hypertension and cerebral edema; in this context, injuries should be identified and treated in a timely manner with a comprehensive approach. Continuous renal replacement therapy is an extracorporeal purification technique that has been gaining ground in the management of acute kidney injury in critically ill patients. Within its modalities, continuous venous venous hemofiltration is described as the therapy of choice in patients with acute brain injury due to its advantages in maintaining hemodynamic stability and reducing the risk of cerebral edema. Optimal control of variables such as timing to start renal replacement therapy, the prescribed dose, the composition of the replacement fluid and the anticoagulation of the extracorporeal circuit will have a significant impact on the evolution of the neurocritical patient with acute kidney injury. There are limited studies evaluating the role of hemofiltration in this context.

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“…Different dialytic strategies may be employed: intermittent hemodialysis (IHD) was initially conceived as a treatment for AKI, while CRRT was developed as an alternative when IHD was not tolerated or contraindicated. CRRT can guarantee a more stable hemodynamic condition than IHD, improving survival expectations and preserving the organ function of treated patients [104].…”

Section: Acute Kidney Injury and Dialysis Choices In Pnh-a Nephrologist's Opinionmentioning

confidence: 99%

Complement Inhibition Therapy and Dialytic Strategies in Paroxysmal Nocturnal Hemoglobinuria: The Nephrologist’s Opinion

Gembillo

Siligato

Cernaro

et al. 2020

JCM

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Paroxysmal nocturnal hemoglobinuria (PNH) is a rare clonal disease that presents an estimated incidence of 1.3 cases per million per year, with a prevalence of 15.9 cases per million. It is characterized by hemolysis, bone marrow dysfunction with peripheral blood cytopenia, hypercoagulability, thrombosis, renal impairment and arterial and pulmonary hypertension. Hemolysis and subsequent hemosiderin accumulation in tubular epithelium cells induce tubular atrophy and interstitial fibrosis. The origin of PNH is the somatic mutation in the X-linked phosphatidylinositol glycan class A (PIG-A) gene located on Xp22: this condition leads to the production of clonal blood cells with a deficiency in those surface proteins that protect against the lytic action of the activated complement system. Despite the increased knowledge of this syndrome, therapies for PNH were still only experimental and symptomatic, until the introduction of the C5 complement blockade agent Eculizumab. A second generation of anti-complement agents is currently under investigation, representing future promising therapeutic strategies for patients affected by PNH. In the case of chronic hemolysis and renal iron deposition, a multidisciplinary approach should be considered to avoid or treat acute tubular injury or acute kidney injury (AKI). New promising perspectives derive from complement inhibitors and iron chelators, as well as more invasive treatments such as immunoadsorption or the use of dedicated hemodialysis filters in the presence of AKI.

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Continuous veno-venous hemofiltration yields better renal outcomes than intermittent hemodialysis among traumatic intracranial hemorrhage patients with acute kidney injury: A nationwide population-based retrospective study in Taiwan

Cited by 4 publications

References 38 publications

Efficacy of two hemodialyses in patients with chronic renal failure complicated by massive intracerebral hemorrhage

Efficacy of two hemodialyses in patients with chronic renal failure complicated by massive intracerebral hemorrhage

Continuous Renal Replacement Therapy in Acute Brain Injury

Complement Inhibition Therapy and Dialytic Strategies in Paroxysmal Nocturnal Hemoglobinuria: The Nephrologist’s Opinion

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