Kidney Replacement Therapy for Fluid Management

Balakumar, V.; Murugan, Raghavan

doi:10.1016/j.ccc.2020.11.006

Cited by 5 publications

(3 citation statements)

References 97 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While conservative fluid management strategies can be helpful in preventing fluid overload in a subset of patients, those with hemodynamic instability typically receive significant amount of fluid that could result in progressive congestion [26]. In cases where renal function is affected, there might be a need for mechanical extraction of fluid to avoid the untoward effects of lingering congestion [21][22][23][24][25][26][27].…”

Section: Discussionmentioning

confidence: 99%

The Science of Extracorporeal Ultrafiltration: Introducing a Novel Miniaturized Device

et al. 2023

View full text Add to dashboard Cite

Introduction. Fluid overload has been associated with untoward outcomes in a variety of clinical settings. Isolated extracorporeal ultrafiltration (UF) allows for mechanical extraction of excess fluid and optimization of volume status without the established risks associated with use of high dose diuretics. Conventional machines for renal replacement therapy can be used to perform isolated UF. However, they typically need high blood flow rates with high circuit volumes and the therapy has to be performed by trained nurses. Herein, we describe a novel device, the Artificial Diuresis-1, or AD 1 (Medica S.p.A., Medolla, Italy), which is a portable technology designed to perform extracorporeal UF at bedside. Materials and Methods. The AD 1 uses a polysulfone mini-filter to generate ultrafiltrate with the help of two forces: blood flow (Qb) and gravity (based on the height at which the ultrafiltrate collection bag is placed). In vitro experiments were performed using human blood to evaluate vascular access pressures and ultrafiltrate volumes using various central venous catheters (12 Fr bilume, 10 Fr with 2 separate lumens, pediatric catheter 7 Fr). A variety of combinations were tested with Qb of 20, 35, 50 mL/min and collection bag height at 20, 40, 60 cm, measuring the UF rate per minute each while monitoring the pressures in the venous and arterial lines and filtration fraction. Results. The device’s performance was as expected. Regarding the pediatric CVC, it was possible to perform measurements only with a Qb of 20 mL/min due to increased venous pressure. Ultrafiltration rates when lines were directly connected to the blood container as well as for CVC Tesio ranged from 3.7 to 11 mL/min, for the CVC Niagara™ from 4.5 to 12.5 mL/min and for the CVC 7 Fr from 8.5 to 10 mL/min. The pressures of the vascular accesses were kept within a range of -5/-40 mmHg for the artery and +10/+70 mmHg for the vein. The highest venous pressure values were found with the CVC 7 Fr (+80/+100 mmHg). Conclusions. This novel device allows to treat patients with fluid overload in a variety of settings, from low-intensity department such as long-term care facilities to the intensive care unit. The device is small and portable, has a simple design, and is user-friendly. Future studies will be needed to evaluate whether gentle ultrafiltration and treatment of volume overload will translate into improvement in clinical outcomes such as a reduction in congestion-related hospital admission.

show abstract

Section: Discussionmentioning

confidence: 99%

The Science of Extracorporeal Ultrafiltration: Introducing a Novel Miniaturized Device

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Daily monitoring of input and output fluids and net patient fluid balance is critical for prevention and early treatment of fluid overload in patients at risk and those with established AKI. The total extent of fluid overload may be best assessed by serial weights, cumulative fluid balance, and clinical examination, possibly aided by specific investigations such as bioelectrical impedance analysis or lung ultrasound [13,14]. Bioimpedance analysis is a noninvasive technology that assesses the electrical properties of tissues by measuring the reactance and resistance of an alternating current passed through the body through an electrode placed on the skin [15].…”

Section: Monitoring Of Fluid Overloadmentioning

confidence: 99%

Fluid Overload and Precision Net Ultrafiltration in Critically Ill Patients

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background: Fluid overload is present in two-thirds of critically ill patients with acute kidney injury and is associated with morbidity, mortality, and increased healthcare resource utilization. Kidney replacement therapy is frequently used for net fluid removal (i.e., net ultrafiltration) in patients with severe oliguric acute kidney injury. However, ultrafiltration has considerable risks associated with it and there is a need for newer technology to perform ultrafiltration safely and to improve outcomes. Summary: Caring for a critically ill patient with oliguric acute kidney injury and fluid overload is one of the most challenging problems. Although diuretics are the first line treatment for management of fluid overload, diuretic resistance is common. Various clinical practice guidelines support fluid removal using ultrafiltration during kidney replacement therapy. Emerging evidence from observational studies in critically ill patients suggests that both slow and fast rates of net fluid removal during continuous kidney replacement therapy are associated with increased mortality compared with moderate UFNET rates. In addition, fast UFNET rates are associated with an increased risk of cardiac arrhythmias. Randomized trials are required to examine whether moderate UFNET rates are associated with a reduced risk of hemodynamic instability, organ injury and improved outcomes in critically ill patients. There is a need for newer technology for fluid removal in patients who do not meet traditional criteria for initiation of KRT. Emerging newer and miniaturized ultrafiltration devices may address an unmet clinical need.

show abstract

“…Despite considerable advances in the assessment of dialysis adequacy with respect to solute removal and data suggesting that net ultrafiltration may be associated with the outcomes 3 – 5 , there is currently no specific measure of adequacy for fluid removal 6 , 7 . Intradialytic hypotension is a common complication associated with RRT; it may be associated with the ultrafiltration rate and can cause further ischemic injury to the recovering kidneys, thereby potentially reducing the probability of renal recovery 4 , 8 . Therefore, the selection of the optimal ultrafiltration rate that will not result in any adverse clinical consequences depends on an accurate estimation of the patient’s fluid status and hemodynamics, an adequate understanding of the principles of fluid overload treatment with ultrafiltration, and clear treatment goals 2 , 9 , 10 , although there are several methods to evaluated volume responsiveness in critically ill patients, these tools are usually used to evaluate patients in a life-threatening condition, as circulatory shock, not to predict hypotension during RRT.…”

mentioning

confidence: 99%

Prediction of hemodynamic tolerance of intermittent hemodialysis in critically ill patients: a cohort study

Passos

Caldas

Ramos

et al. 2021

Sci Rep

View full text Add to dashboard Cite

The evaluation and management of fluid balance are key challenges when caring for critically ill patients requiring renal replacement therapy. The aim of this study was to assess the ability of clinical judgment and other variables to predict the occurrence of hypotension during intermittent hemodialysis (IHD) in critically ill patients. This was a prospective, observational, single-center study involving critically ill patients undergoing IHD. The clinical judgment of hypervolemia was determined by the managing nephrologists and critical care physicians in charge of the patients on the basis of the clinical data used to calculate the ultrafiltration volume and rate for each dialysis treatment. Seventy-nine (31.9%) patients presented with hypotension during IHD. Patients were perceived as being hypervolemic in 109 (43.9%) of the cases by nephrologists and in 107 (43.1%) by intensivists. The agreement between nephrologists and intensivists was weak (kappa = 0.561). Receiver operating characteristic curve analysis yielded an AUC of 0.81 (95% CI 0.75 to 0.84; P < 0.0001), and a cutoff value of 70 mm for the vascular pedicle width (VPW) had the highest accuracy for the prediction of the absence of hypotension. The clinical judgment of hypervolemia did not predict hypotension during IHD. The high predictive ability of the VPW may assist clinicians with critical thinking.

show abstract

Kidney Replacement Therapy for Fluid Management

Cited by 5 publications

References 97 publications

The Science of Extracorporeal Ultrafiltration: Introducing a Novel Miniaturized Device

The Science of Extracorporeal Ultrafiltration: Introducing a Novel Miniaturized Device

Fluid Overload and Precision Net Ultrafiltration in Critically Ill Patients

Prediction of hemodynamic tolerance of intermittent hemodialysis in critically ill patients: a cohort study

Contact Info

Product

Resources

About