Renal Replacement Therapy in Acute Kidney Injury: Which Mode and When?

Lobo, Valentine

doi:10.5005/jp-journals-10071-23383

Cited by 8 publications

(10 citation statements)

References 14 publications

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“…Continuous renal replacement therapy is often utilized in renal replacement therapy for critically ill patients, especially for those with hemodynamic instability ( 21 ). CRRT treatment for critically ill patients removes excess water and certain potentially toxic macromolecular compounds ( 22 ). Several studies had shown that insufficient CRRT treatment would result in adverse outcomes for patients.…”

Section: Discussionmentioning

confidence: 99%

Serum Albumin Before CRRT Was Associated With the 28- and 90-Day Mortality of Critically Ill Patients With Acute Kidney Injury and Treated With Continuous Renal Replacement Therapy

Wang

Sun

et al. 2021

Front. Nutr.

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Introduction: Although low serum albumin (ALB) may worsen acute kidney injury (AKI), additional study is needed to establish the connection between ALB and the prognosis of critically ill patients with AKI and treated with continuous renal replacement therapy (CRRT).Methods:A secondary analysis of a bi-center, retrospective, and observational study, such as critically ill patients with AKI and treated with CRRT from January 2009 to September 2016. The univariate analysis, multi-factor regression analysis, sensitivity analysis, and curve-fitting analysis were applied to explore the association of ALB with the 28 and 90 days mortality of critically ill patients with AKI and treated with CRRT, and the removal efficiency of serum phosphorus.Results: From January 2009 to September 2016, 1,132 cases with AKI and treated with CRRT met the inclusion criteria and enrolled in this study. We found that the higher ALB before CRRT, the lower the 28- and 90-day mortality of patients with AKI and treated with CRRT, the higher removal efficiency of serum phosphorus, the adjusted hazard ratio (HR) value for 28-day mortality in the four models were separately 0.92 (0.90, 0.95), 0.91 (0.89, 0.94), 0.92 (0.89, 0.95), and 0.92 (0.89, 0.95); the adjusted HR value for 90 day mortality in the four models were 0.91 (0.89, 0.94), 0.92 (0.89, 0.95), 0.92 (0.89, 0.95), and 0.92 (0.89, 0.96); the adjusted OR value for the removal efficiency of serum phosphorus in the four models were separately −0.04 (−0.07, −0.01), −0.05 (−0.08, −0.01), −0.04 (−0.08, −0.01), and −0.04 (−0.08, −0.01). The sensitivity analysis and curve-fitting analysis also showed that ALB before CRRT was correlated with the 28 and 90 days mortality of critically ill patients with AKI and treated with CRRT and the removal efficiency of serum phosphorus.Conclusion: The higher the serum ALB before CRRT, the lower the mortality of critically ill patients with AKI and treated with CRRT, and the higher the clearance efficiency of serum phosphorus.

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Section: Discussionmentioning

confidence: 99%

Serum Albumin Before CRRT Was Associated With the 28- and 90-Day Mortality of Critically Ill Patients With Acute Kidney Injury and Treated With Continuous Renal Replacement Therapy

Wang

Sun

et al. 2021

Front. Nutr.

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“…Further, procedural details such as the type of catheter (rigid vs. flexible) or buffer (lactate acetate vs. bicarbonate) used [ 3 ] and the time of initiation of KRT may be potential confounders but were not reported by most of the included studies. Finally, this systematic review and meta-analysis was conducted to include different techniques of the three primary dialysis modalities, and, therefore, we did not search for studies reporting mortality outcomes with CRRT, HD, or PD techniques alone.…”

Section: Discussionmentioning

confidence: 99%

“…A severe decline in kidney function (GFR < 15 ml/min/1.73 m 2 ) due to either AKI [ 3 ] or CKD [ 4 ] necessitated life-saving support using kidney replacement therapy (KRT). The global use of KRT has increased by 43% from 1990 to 2017 [ 1 ], mirroring the global increase in the incidence of AKI [ 5 ] and CKD [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Mortality and mode of dialysis: meta-analysis and systematic review

Chander,

Luhana,

Sadarat

et al. 2024

BMC Nephrol

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Background The global use of kidney replacement therapy (KRT) has increased, mirroring the incidence of acute kidney injury and chronic kidney disease. Despite its growing clinical usage, patient outcomes with KRT modalities remain controversial. In this meta-analysis, we sought to compare the mortality outcomes of patients with any kidney disease requiring peritoneal dialysis (PD), hemodialysis (HD), or continuous renal replacement therapy (CRRT). Methods The investigation was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed (MEDLINE), Cochrane Library, and Embase databases were screened for randomized trials and observational studies comparing mortality rates with different KRT modalities in patients with acute or chronic kidney failure. A random-effects model was applied to compute the risk ratio (RR) and 95% confidence intervals (95%CI) with CRRT vs. HD, CRRT vs. PD, and HD vs. PD. Heterogeneity was assessed using I2 statistics, and sensitivity using leave-one-out analysis. Results Fifteen eligible studies were identified, allowing comparisons of mortality risk with different dialytic modalities. The relative risk was non-significant in CRRT vs. PD [RR = 0.95, (95%CI 0.53, 1.73), p = 0.92 from 4 studies] and HD vs. CRRT [RR = 1.10, (95%CI 0.95, 1.27), p = 0.21 from five studies] comparisons. The findings remained unchanged in the leave-one-out sensitivity analysis. Although PD was associated with lower mortality risk than HD [RR = 0.78, (95%CI 0.62, 0.97), p = 0.03], the significance was lost with the exclusion of 4 out of 5 included studies. Conclusion The current evidence indicates that while patients receiving CRRT may have similar mortality risks compared to those receiving HD or PD, PD may be associated with lower mortality risk compared to HD. However, high heterogeneity among the included studies limits the generalizability of our findings. High-quality studies comparing mortality outcomes with different dialytic modalities in CKD are necessary for a more robust safety and efficacy evaluation.

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“…Data were collected for the following parameters: age, sex, total fluid input and output, serum creatinine, urea, procalcitonin, CRP, Hb, blood lactate, arterial and venous blood gas analysis, parameters of coagulation system and liver, serum electrolytes, and arginine, ornithine, ADMA, SDMA, DMA, and citrulline. Additionally, patients were assessed with respect to their need for CRRT [ 31 ].…”

Section: Methodsmentioning

confidence: 99%

Measurement of Serum Levels of 5 Amino Acids and Dimethylamine Using Liquid Chromatography-Tandem Mass Spectrometry in Patients without Septic Associated Acute Kidney Injury and with Septic Associated Acute Kidney Injury Requiring Continuous Renal Replacement Therapy

et al. 2022

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Background Acute kidney injury (AKI) is one of the most common organ failures. An early diagnosis of AKI using specific biomarkers is essential for effective treatment. This study determined the serum concentrations of selected amino acids and amines using targeted liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) in patients with AKI during sepsis and septic shock treated in the Intensive Care Unit (ICU). Material/Methods A sample of 41 patients was divided into 2 groups: (1) patients with sepsis and septic shock along required continuous renal replacement therapy (CRRT) due to AKI (n=13), and (2) patients with sepsis and septic shock but without AKI (n=28). LC-MS/MS was used to measure a serum concentration of 6 amino acids and amines: arginine, ornithine, asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), dimethylamine (DMA), and citrulline. Results There was a statistically significantly higher median DMA level in AKI patients compared to those without AKI (8.1 vs 5.2 umol/L; P =0.022). The results for the remaining molecules showed no significant differences ( P >0.05). Patients with DMA ≥14.95 umol/L (n=5; 100%) and treated with CRRT presented DMA level below the cut-off point (n=7; 20%). Subjects with creatinine levels ≥1.19 mg/dL (n=11; 28%) and treated with CRRT presented creatinine levels below the cut-off point (n=1; 3%). Conclusions In patients with sepsis, increased serum levels of DMA were significantly associated with AKI requiring CRRT. It remains unclear whether increased DMA concentrations are secondary to sepsis-induced AKI or are a cause.

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Renal Replacement Therapy in Acute Kidney Injury: Which Mode and When?

Cited by 8 publications

References 14 publications

Serum Albumin Before CRRT Was Associated With the 28- and 90-Day Mortality of Critically Ill Patients With Acute Kidney Injury and Treated With Continuous Renal Replacement Therapy

Serum Albumin Before CRRT Was Associated With the 28- and 90-Day Mortality of Critically Ill Patients With Acute Kidney Injury and Treated With Continuous Renal Replacement Therapy

Mortality and mode of dialysis: meta-analysis and systematic review

Measurement of Serum Levels of 5 Amino Acids and Dimethylamine Using Liquid Chromatography-Tandem Mass Spectrometry in Patients without Septic Associated Acute Kidney Injury and with Septic Associated Acute Kidney Injury Requiring Continuous Renal Replacement Therapy

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