How To Prescribe And Troubleshoot Continuous Renal Replacement Therapy: A Case-Based Review

Neyra, Javier A.; Yessayan, Lenar; Bastin, Melissa L. Thompson; Wille, Keith; Tolwani, Ashita J.

doi:10.34067/kid.0004912020

Cited by 12 publications

(10 citation statements)

References 78 publications

(85 reference statements)

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“…This clearly highlights the need for interventions to close this gap. In day to day practice, fluid management during CRRT is prescribed per specific patient fluid balance goals within a predefined period of time [ 25 ]. If negative fluid balance to manage FO in a patient on CRRT is desired, clinicians prescribe -for example- patient fluid balance as net negative FB of 100 ml/h to target net negative FB of ~2.4 liters in the next 24 h. To achieve this goal, bedside ICU or dialysis nurses calculate specific NUF targets each hour and program the CRRT machine to execute this hourly NUF.…”

Section: Discussionmentioning

confidence: 99%

Assessment of prescribed vs. achieved fluid balance during continuous renal replacement therapy and mortality outcome

et al. 2022

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Background Fluid management during continuous renal replacement therapy (CRRT) requires accuracy in the prescription of desired patient fluid balance (FBGoal) and precision in the attainable patient fluid balance (FBAchieved). Herein, we examined the association of the gap between prescribed vs. achieved patient fluid balance during CRRT (%FBGap) with hospital mortality in critically ill patients. Methods Cohort study of critically ill adults with acute kidney injury (AKI) requiring CRRT and a prescription of negative fluid balance (mean patient fluid balance goal of negative ≥0.5 liters per day). Fluid management parameters included: 1) NUF (net ultrafiltration rate); 2) FBGoal; 3) FBAchieved; and 4) FBGap (% gap of fluid balance achieved vs. goal), all adjusted by patient’s weight (kg) and duration of CRRT (hours). Results Data from 653 patients (median of 102.2 patient-hours of CRRT) were analyzed. Mean (SD) age was 56.7 (14.6) years and 61.9% were male. Hospital mortality rate was 64%. Despite FBGoal was similar in patients who died vs. survived, survivors achieved greater negative fluid balance during CRRT than non-survivors: median FBAchieved -0.25 [-0.52 to -0.05] vs. 0.06 [-0.26 to 0.62] ml/kg/h, p<0.001. Median NUF was lower in patients who died vs. survived: 1.06 [0.63–1.47] vs. 1.22 [0.82–1.69] ml/kg/h, p<0.001, and median %FBGap was higher in patients who died (112.8%, 61.5 to 165.7) vs. survived (64.2%, 30.5 to 91.8), p<0.001. In multivariable models, higher %FBGap was independently associated with increased risk of hospital mortality: aOR (95% CI) 1.01 (1.01–1.02), p<0.001. NUF was not associated with hospital mortality when adjusted by %FBGap and other clinical parameters: aOR 0.96 (0.72–1.28), p = 0.771. Conclusions Higher %FBGap was independently associated with an increased risk of hospital mortality in critically ill adults with AKI on CRRT in whom clinicians prescribed negative fluid balance via CRRT. %FBGap represents a novel quality indicator of CRRT delivery that could assist with operationalizing fluid management interventions during CRRT.

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Section: Discussionmentioning

confidence: 99%

Assessment of prescribed vs. achieved fluid balance during continuous renal replacement therapy and mortality outcome

et al. 2022

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“…Regional citrate anticoagulation does come at the expense of increased complexity and the need to monitor for metabolic complications. The most feared complication is citrate accumulation, which is also known as citrate toxicity or citrate lock but which should be differentiated from citrate excess (Table 4) (55). Citrate excess causes metabolic alkalosis because each citrate molecule is metabolized to three molecules of bicarbonate, whereas citrate toxicity can result in dangerously low systemic iCa levels along with (due to accumulating calcium-citrate complexes) increased total calcium (tCa) levels, escalating intravenous calcium requirements, and anion gap metabolic acidosis (56).…”

Section: Anticoagulationmentioning

confidence: 99%

Continuous KRT

Teixeira

Neyra

Tolwani

2022

CJASN

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AKI is a common complication of critical illness and is associated with substantial morbidity and risk of death. Continuous KRT comprises a spectrum of dialysis modalities preferably used to provide kidney support to patients with AKI who are hemodynamically unstable and critically ill. The various continuous KRT modalities are distinguished by different mechanisms of solute transport and use of dialysate and/or replacement solutions. Considerable variation exists in the application of continuous KRT due to a lack of standardization in how the treatments are prescribed, delivered, and optimized to improve patient outcomes. In this manuscript, we present an overview of the therapy, recent clinical trials, and outcome studies. We review the indications for continuous KRT and the technical aspects of the treatment, including continuous KRT modality, vascular access, dosing of continuous KRT, anticoagulation, volume management, nutrition, and continuous KRT complications. Finally, we highlight the need for close collaboration of a multidisciplinary team and development of quality assurance programs for the provision of high-quality and effective continuous KRT.

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“…The terminology in this text was based on the dialysis methods approved by ANVISA up to the date of document preparation. extracorporeal artificial kidney Support -Continuous hemodiafiltration [23][24][25][26] .…”

Section: Modalitiesmentioning

confidence: 99%

Acute kidney injury and renal replacement therapy: terminology standardization

et al. 2022

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The Department of Acute Kidney Injury (IRA) of the Brazilian Society of Nephrology prepared this document for the purpose of standardizing AKI terminology and dialysis modalities in the Portuguese language for Brazil. Several terms with similar meanings have been used in AKI and its dialysis modalities, causing confusion and disparities among patients, nephrologists, health institutions, private care companies, insurance companies and government entities. These disparities can impact medical care, hospital organization and care, as well as the funding and reimbursement of AKI-related procedures. Thus, consensual nomenclature and definitions were developed, including the definitions of AKI, acute kidney disease (AKD) and chronic kidney disease (CKD). Additionally, we addressed all dialysis modalities and extracorporeal procedures related to AKI, currently approved and available in the country. The Brazilian Society of Nephrology hopes that this Consensus can standardize the terminology and provide technical support to all involved in AKI care in Brazil.

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How To Prescribe And Troubleshoot Continuous Renal Replacement Therapy: A Case-Based Review

Cited by 12 publications

References 78 publications

Assessment of prescribed vs. achieved fluid balance during continuous renal replacement therapy and mortality outcome

Assessment of prescribed vs. achieved fluid balance during continuous renal replacement therapy and mortality outcome

Continuous KRT

Acute kidney injury and renal replacement therapy: terminology standardization

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