Effect of the intensity of continuous renal replacement therapy in patients with sepsis and acute kidney injury: a single-center randomized clinical trial

Zhang, Ping; Yang, Yi; Lü, Rong; Zhang, Yuntao; Xie, Wanzhuo; Chen, Jiang Hua

doi:10.1093/ndt/gfr486

Cited by 72 publications

(80 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The current KDIGO guidelines recommend a standard dialysis dose of 35 ml/kg/h to ascertain delivery of at least 25 ml/kg/h [21]. High-volume CVVH does not offer any more benefit [22,23]. …”

Section: Crrt-related Strategies To Avoid Colistin Toxicitymentioning

confidence: 99%

Continuous Renal Replacement Therapy-Related Strategies to Avoid Colistin Toxicity: A Clinically Orientated Review

et al. 2014

View full text Add to dashboard Cite

Polymyxins are ‘old' antimicrobials which were abandoned for almost 30 years because of significant renal and neurological toxicity. However, the alarming rise in multiresistant Gram-negative bacterial infections worldwide has revived interest in these ‘forgotten' agents. Colistin (polymyxin E) is one of the main antibiotics of this class. It is most often administered as the prodrug colistimethate sodium. Doses for treatment of systemic infections in adults range between 3 and 9 million IU per day. Colistin is increasingly used to treat pneumonia and bacteremia in critically ill patients. During their intensive care unit stay, many of these patients will need continuous renal replacement therapy (CRRT) because of acute kidney injury or an unstable hemodynamic condition. Based on recent pharmacological data and our own experience, we postulate that patients undergoing CRRT may receive substantially higher doses of colistin (i.e. a high loading dose, followed by a maintenance dose of up to 4.5 million IU t.i.d.). Treatment can be continued for a prolonged time period without increasing toxicity. CRRT counteracts colistin accumulation because the drug is continuously filtered and also significantly adsorbed in the bulk of the dialysis membrane. Implementing such a ‘CRRT rescue' therapy does require the strict use of highly adsorptive dialysis membranes in association with citrate anticoagulation to increase membrane performance.

show abstract

“…The current KDIGO guidelines recommend a standard dialysis dose of 35 ml/kg/h to ascertain delivery of at least 25 ml/kg/h [21]. High-volume CVVH does not offer any more benefit [22,23]. …”

Section: Crrt-related Strategies To Avoid Colistin Toxicitymentioning

confidence: 99%

Continuous Renal Replacement Therapy-Related Strategies to Avoid Colistin Toxicity: A Clinically Orientated Review

et al. 2014

View full text Add to dashboard Cite

show abstract

“…[38] A prospective randomized study is needed to confirm this observation. High-volume hemofiltration has no place in the treatment of SAKI [36,39] now-a-days. In current practice a dialysis dose of 35 ml/kg/h is prescribed to ascertain delivery of at least 25 mL/kg/h.…”

Section: Renal Replacement Modalitiesmentioning

confidence: 99%

New insights in prevention and treatment of sepsis-induced acute kidney injury

Honoré

Jacobs

Joannès-Boyau

et al. 2013

Journal of Translational Internal Medicine

View full text Add to dashboard Cite

Sepsis-induced acute kidney injury (SAKI) remains an important challenge for intensive care unit clinicians. We reviewed current available evidence regarding prevention and treatment of SAKI thereby incorporating some major recent advances and developments. Prevention includes early and ample administration of "balanced" crystalloid solutions such as Ringer's lactate. For monitoring of renal function during resuscitation, lactate clearance rate is preferred above S cv O 2 or renal Doppler. Aiming at high central venous pressures seems to be deleterious in light of the novel "kidney afterload" concept. Noradrenaline is the vasopressor of choice for preventing SAKI. Intra-abdominal hypertension, a potent trigger of acute kidney injury in postoperative and trauma patients, should not be neglected in sepsis. Renal replacement therapy (RRT) must be started early in fluid-overloaded patients refractory to diuretics. Continuous RRT (CRRT) is the preferred modality in hemodynamically unstable SAKI but its use in more stable SAKI is increasing. In the absence of hypervolemia, diuretics should be avoided. Antimicrobial dosing during CRRT needs to be thoroughly reconsidered to assure adequate infection control.

show abstract

“…But the assumption of 'more being better' in this setting is rather not supported by recent data [3] . In a randomized study enrolling 280 patients with sepsis and AKI, Zhang et al [4] found no differences in survival at 28, 60 and 90 days with treatment doses of 50 and 85 ml/kg/h. A subgroup analysis of septic shock patients treated with the higher dose did not indicate any survival benefit either.…”

Section: Introductionmentioning

confidence: 99%

Relative Blood Volume Monitoring during Renal Replacement Therapy in Critically Ill Patients with Septic Shock: A Preliminary Report

et al. 2015

View full text Add to dashboard Cite

Background: Volume management during renal replacement therapy (RRT) in septic shock is always in the conflict between aggravating hypovolemia by undue ultrafiltration (UF) and insufficient reduction of fluid overload which is associated with adverse outcome. Relative blood volume (RBV) monitoring could be helpful for timely transition from fluid resuscitation to fluid removal. Methods: Data of RBV were continuously monitored and used for guidance of UF and fluid resuscitation in 21 consecutive patients with severe septic multiple organ failure. RRT was applied with extended daily hemodiafiltration for median 11 h (range 6-23). Changes in RBV were analyzed during the first 4 treatment sessions. Results: During 26 treatments, RBV monitoring revealed an internal volume loss substituted by a median infusion volume of 2.38 l (maximum 8.07 l) per treatment to keep the RBV constant. In the remaining 40 sessions, a median net-UF of 1.00 l (range 0.40-4.40) was achieved. In the first 2 days predominantly substitution was necessary whereas from the third day UF became increasingly possible. The 28-day survival rate was 81%. Conclusion: Blood volume monitoring proved to be an easy and feasible tool for safe guidance of fluid management maintaining the balance between UF and vascular refilling. Video Journal Club ‘Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=433415.

show abstract

Effect of the intensity of continuous renal replacement therapy in patients with sepsis and acute kidney injury: a single-center randomized clinical trial

Abstract: In patients with sepsis and AKI, increasing the intensity of renal replacement therapy from 50 (HVHF) to 85 mL/kg/h (EHVHF) had no effect on survival at 28 and 90 days.

Cited by 72 publications

References 34 publications

Continuous Renal Replacement Therapy-Related Strategies to Avoid Colistin Toxicity: A Clinically Orientated Review

Continuous Renal Replacement Therapy-Related Strategies to Avoid Colistin Toxicity: A Clinically Orientated Review

New insights in prevention and treatment of sepsis-induced acute kidney injury

Relative Blood Volume Monitoring during Renal Replacement Therapy in Critically Ill Patients with Septic Shock: A Preliminary Report

Contact Info

Product

Resources

About