Epidemiology and Outcomes of AKI Treated With Continuous Kidney Replacement Therapy: The Multicenter CRRTnet Study

Rewa, Oleksa; Ortiz-Soriano, Victor; Lambert, Joshua; Kabir, Shaowli; Heung, Michael; House, Andrew A.; Monga, Divya; Juncos, Luis A.; Secic, Michelle; Piazza, Robin; Goldstein, Stuart L.; Bagshaw, Sean M.; Neyra, Javier A.

doi:10.1016/j.xkme.2023.100641

Kidney Medicine

2023

DOI: 10.1016/j.xkme.2023.100641

|View full text |Cite

Epidemiology and Outcomes of AKI Treated With Continuous Kidney Replacement Therapy: The Multicenter CRRTnet Study

Oleksa Rewa¹,

Victor Ortiz-Soriano²,

Joshua Lambert³

et al.

Help me understand this report

Search citation statements

Order By: Relevance

Paper Sections

Select...

Citation Types

Supporting

Mentioning

Contrasting

Year Published

2023

2024

Publication Types

Select...

Article7

Relationship

Self Cite1

Independent6

Authors

Journals

Cited by 7 publications

(2 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a multinational prospective study (AKI-Epidemiology trial), 57% of the patients in the ICU had AKI, and 13.5% required renal replacement therapy, of which the majority (75%) were CRRT (2). CRRT modalities such as continuous venovenous hemofiltration (CVVHF) and continuous venovenous hemodialysis (CVVHD) allow for acid-base, electrolyte, and volume management with a goal of achieving hemodynamic stability in patients with AKI; however, mortality rates remain high at 50-70% (3)(4)(5)(6). The optimal dosing of medications in patients receiving CRRT remains an area of active research and growing data have shown that CRRT modalities and settings (e.g., modes, blood flow rate, effluent flow rate [Q E ], filter material, and size) may impair the achievement of therapeutic exposures of drugs, particularly renally eliminated drugs (7)(8)(9)(10)(11).…”

mentioning

confidence: 99%

A New Dosing Frontier: Retrospective Assessment of Effluent Flow Rates and Residual Renal Function Among Critically Ill Patients Receiving Continuous Renal Replacement Therapy

Lakshmipathy,

Ye,

Kuti

et al. 2024

Critical Care Explorations

View full text Add to dashboard Cite

OBJECTIVES: In 2020, cefiderocol became the first Food and Drug Administration-approved medication with continuous renal replacement therapy (CRRT) dosing recommendations based on effluent flow rates (Q E). We aimed to evaluate the magnitude and frequency of factors that may influence these recommendations, that is, Q E intrapatient variability and residual renal function. DESIGN: Retrospective observational cohort study. SETTING: ICUs within Hartford Hospital (890-bed, acute-care hospital) in Connecticut from 2017 to 2023. PATIENTS: Adult ICU patients receiving CRRT for greater than 72 hours. MEASUREMENTS AND MAIN RESULTS: CRRT settings including Q E and urine output (UOP) were extracted from the time of CRRT initiation (0 hr) and trends were assessed. To assess the impact on antibiotic dosing, cefiderocol doses were assigned to 0 hour, 24 hours, 48 hours, and 72 hours Q E values per product label, and the proportion of antibiotic dose changes required as a result of changes in inpatient’s Q E was evaluated. Among the 380 ICU patients receiving CRRT for greater than 72 hours, the median (interquartile range) 0 hour Q E was 2.96 (2.35–3.29) L/hr. Approximately 9 Q E values were documented per patient per 24-hour window. Q E changes of greater than 0.75 L/hr were observed in 21.6% of patients over the first 24 hours and in 7.9% (24–48 hr) and 5.8% (48–72 hr) of patients. Approximately 40% of patients had UOP greater than 500 mL at 24 hours post-CRRT initiation. Due to Q E changes within 24 hours of CRRT initiation, a potential cefiderocol dose adjustment would have been warranted in 38% of patients (increase of 21.3%; decrease of 16.6%). Q E changes were less common after 24 hours, warranting cefiderocol dose adjustments in less than 15% of patients. CONCLUSIONS: Results highlight the temporal and variable dynamics of Q E and prevalence of residual renal function. Data also demonstrate a risk of antibiotic under-dosing in the first 24 hours of CRRT initiation due to increases in Q E. For antibiotics with Q E-based dosing recommendations, empiric dose escalation may be warranted in the first 24 hours of CRRT initiation.

show abstract

mentioning

confidence: 99%

A New Dosing Frontier: Retrospective Assessment of Effluent Flow Rates and Residual Renal Function Among Critically Ill Patients Receiving Continuous Renal Replacement Therapy

Lakshmipathy,

Ye,

Kuti

et al. 2024

Critical Care Explorations

View full text Add to dashboard Cite

show abstract

“…Furthermore, clinical trials investigating the intensity of RRT have demonstrated differences in the practices regarding the use of intermittent RRT across regions ( 13 , 14 ). Additionally, observational studies have reported significant heterogeneity in RRT practice patterns within North America ( 15 , 16 ). Regarding FB management using ultrafiltration, an international survey has revealed significant practice variation ( 4 ), also regionally in North America ( 17 ) and Europe ( 18 ).…”

mentioning

confidence: 99%

Regional Practice Variation and Outcomes in the Standard Versus Accelerated Initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) Trial: A Post Hoc Secondary Analysis

Vaara,

Serpa Neto,

Bellomo

et al. 2024

Critical Care Explorations

Self Cite

View full text Add to dashboard Cite

OBJECTIVES: Among patients with severe acute kidney injury (AKI) admitted to the ICU in high-income countries, regional practice variations for fluid balance (FB) management, timing, and choice of renal replacement therapy (RRT) modality may be significant. DESIGN: Secondary post hoc analysis of the STandard vs. Accelerated initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial (ClinicalTrials.gov number NCT02568722). SETTING: One hundred-fifty-three ICUs in 13 countries. PATIENTS: Altogether 2693 critically ill patients with AKI, of whom 994 were North American, 1143 European, and 556 from Australia and New Zealand (ANZ). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Total mean FB to a maximum of 14 days was +7199 mL in North America, +5641 mL in Europe, and +2211 mL in ANZ (p < 0.001). The median time to RRT initiation among patients allocated to the standard strategy was longest in Europe compared with North America and ANZ (p < 0.001; p < 0.001). Continuous RRT was the initial RRT modality in 60.8% of patients in North America and 56.8% of patients in Europe, compared with 96.4% of patients in ANZ (p < 0.001). After adjustment for predefined baseline characteristics, compared with North American and European patients, those in ANZ were more likely to survive to ICU (p < 0.001) and hospital discharge (p < 0.001) and to 90 days (for ANZ vs. Europe: risk difference [RD], –11.3%; 95% CI, –17.7% to –4.8%; p < 0.001 and for ANZ vs. North America: RD, –10.3%; 95% CI, –17.5% to –3.1%; p = 0.007). CONCLUSIONS: Among STARRT-AKI trial centers, significant regional practice variation exists regarding FB, timing of initiation of RRT, and initial use of continuous RRT. After adjustment, such practice variation was associated with lower ICU and hospital stay and 90-day mortality among ANZ patients compared with other regions.

show abstract

Risk prediction models for successful discontinuation in acute kidney injury undergoing continuous renal replacement therapy

Zhong,

Min,

Zhang

et al. 2024

iScience

View full text Add to dashboard Cite

scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.

Contact Info

hi@scite.ai

10624 S. Eastern Ave., Ste. A-614

Henderson, NV 89052, USA

Blog Terms and Conditions API Terms Privacy Policy Contact Cookie Preferences Do Not Sell or Share My Personal Information

Made with 💙 for researchers

Part of the Research Solutions Family.

Epidemiology and Outcomes of AKI Treated With Continuous Kidney Replacement Therapy: The Multicenter CRRTnet Study

Cited by 7 publications

References 24 publications

A New Dosing Frontier: Retrospective Assessment of Effluent Flow Rates and Residual Renal Function Among Critically Ill Patients Receiving Continuous Renal Replacement Therapy

A New Dosing Frontier: Retrospective Assessment of Effluent Flow Rates and Residual Renal Function Among Critically Ill Patients Receiving Continuous Renal Replacement Therapy

Regional Practice Variation and Outcomes in the Standard Versus Accelerated Initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) Trial: A Post Hoc Secondary Analysis

Risk prediction models for successful discontinuation in acute kidney injury undergoing continuous renal replacement therapy

Contact Info

Product

Resources

About