THE CLINICAL APPLICATION OF CRRT—CURRENT STATUS: Continuous Renal Replacement Therapy in Sepsis and Multisystem Organ Failure

Abstract

This study reviews the role of continuous renal replacement therapy (CRRT) in sepsis with acute kidney injury (AKI) and septic shock with multiple organ failure. In addition to the conventional aim of replacing renal function in AKI, CRRT is often used with the concept of modulating immune response in sepsis. With the intention of influencing circulating levels of inflammatory mediators like cytokines and chemokines, the complement system, as well as factors of the coagulation system, several modifications of CRRT have been developed over the last years. These include high volume hemofiltration, high adsorption hemofiltration, use of high cut-off membranes, and hybrid systems like coupled plasma filtration absorbance. One of the most promising concepts may be the development of renal assist devices using renal tubular cells for implementing renal tubular function into CRRT.

Prognostic Factors and Efficacy for Continuous Renal Replacement Therapy in Critically Ill Patients: A Chinese Single-Center Retrospective Study

“…Moreover, the PCO 2 was also decreased after CRRT. The explanation is that CRRT relieve fluid overload and improve the renal perfusion caused by AKI or heart failure [25]. The liver function was also improved by decreased aspartate aminotransferase and bilirubin which could be explained by improved overall conditions (organ perfusion and homeostasis).…”

Construction of an Erythropoietin-Expressing Bioartificial Renal Tubule Assist Device

“…Indeed, removal of inflammatory factors and improved prognosis were found in patients when treated by continuous renal replacement therapy (CRRT) in the clinic. 22 The loss of albumin with a molecular weight of about 66 kDa through the hemofilter membrane was also a common phenomenon in the clinic, too. 23 It is theoretically possible that Epo with a molecular weight of 30.4 kDa can also be filtered across the membrane, though there are no reports about the loss of Epo in the process of hemodialysis or hemofiltration currently.…”

Sepsis and cardiorenal syndrome: Etiopathogenesis, diagnosis and treatment

“…It provides an opportunity to use CRRT not only as supportive therapy, but also but also as a treatment to prevent injury progression and the development of multiple organ dysfunction syndrome in septic patients [50,51].…”

“…High-volume continuous veno-venous haemofiltration (HVHF) is used for the removal of pro-and antiinflammatory mediators, due to the high convective transport, at > 35 mL/kg/h. It may be used continuously, with an ultrafiltration rate of 50-70 mL/kg/h (35-80 mL/kg/h) over 24 hours, or as pulse high-volume haemofiltration, with an ultrafiltration rate of 85-100 mL/kg/h (100-120 mL/ kg/h) over 4-8 hours, followed by the standard dose afterwards [48][49][50]. High-volume haemofiltration significantly reduces the concentration of inflammatory mediators and restores the balance between inflammatory syndrome and compensatory anti-inflammatory systemic responses [41-45, 50, 51].…”