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Books on the topic 'Continuous renal replacement therapy (CRRT)'

Author: Grafiati

Published: 11 December 2022

Last updated: 26 January 2023

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1

P, Paganini Emil, ed. Acute continuous renal replacement therapy. Boston: M. Nijhoff, 1986.

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2

Paganini, Emil P., ed. Acute Continuous Renal Replacement Therapy. Boston, MA: Springer US, 1986. http://dx.doi.org/10.1007/978-1-4613-2311-2.

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3

Assadi, Farahnak, and Fatemeh Ghane Sharbaf. Pediatric Continuous Renal Replacement Therapy. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-26202-4.

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4

Schetz, Miet, and Andrew Davenport. Continuous renal replacement therapy. Edited by Norbert Lameire. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0234.

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After its introduction, continuous renal replacement therapy (CRRT) has found widespread acceptance amongst physicians taking care of critically ill patients. Various modalities (haemofiltration, haemodialysis, haemodiafiltration) are used. As for all types of renal replacement therapy, a good functioning vascular access is an absolute requirement. Whether CRRT is to be preferred over intermittent haemodialysis remains a matter of debate, but haemodynamic instability and risk of cerebral oedema are generally considered indications for CRRT. Whereas under-dosing should certainly be avoided, increasing the dose over an actually delivered effluent flow of 20–25 mL/kg/hour does not appear to improve outcome.One of the major drawbacks of CRRT is the requirement for continuous anticoagulation. Citrate anticoagulation is gaining popularity and represents a valuable alternative, especially in patients with bleeding risk. Other potential complications of CRRT include thermal, nutrient, and drug losses, and acid–base and electrolyte disturbances.

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5

Schneider, Antoine G., Neil J. Glassford, and Rinaldo Bellomo. Choice of Renal Replacement Therapy and Renal Recovery. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199653461.003.0038.

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Acute kidney injury (AKI) is a major complication of critical illness, associated with increased mortality and morbidity. Among survivors of AKI, a subset will develop the need for chronic dialysis. Chronic dialysis imposes a major physical, emotional, economic, and social burden on ICU survivors and their caregivers. Evidence suggests that the type of renal replacement therapy used in the acute setting may affect renal recovery differently. For example, intermittent haemodialysis (IHD) increases the risk of hypotension and acute volume and solute fluctuations, and such physiological events have been associated with fresh renal injury. In contrast, continuous renal replacement therapy (CRRT) does not carry such risks. Consistent with such physiological and experimental observations and differences, several observational studies and some randomized controlled trials suggest that using IHD, instead of CRRT, as the preferred form of RRT increases the risk of patients entering a chronic dialysis programme. A recent meta-analysis confirmed these findings. Clinicians making decisions about the choice of RRT modality in ICU patients should carefully consider these observations.

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6

Ricci, Zaccaria, and Claudio Ronco. Continuous haemofiltration techniques in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0214.

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Continuous renal replacement therapy (CRRT) is currently considered the mainstay of treatment for severe acute kidney injury. CRRT helps in restoration of fluid balance, control of hyperazotaemia, acid-base imbalances, and electrolyte abnormalities. Most importantly, due to its gradual, low efficiency, continuous solute and water removal, it ensures haemodynamic stability in critically-ill patients being treated with a high level of inotropic support and those with cardiovascular failure. This chapter will discuss the different solute removal techniques (diffusion and convection) and CRRT modalities (ultrafiltration, haemofiltration and haemodialysis). Insights on CRRT prescription and anticoagulation regimens will also be described on the light of the most recent clinical evidence.

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7

Ronco, Claudio, Rinaldo Bellomo, and John A. Kellum. Continuous Renal Replacement Therapy. Oxford University Press, Incorporated, 2016.

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8

A, Kellum John, Bellomo R. 1956-, and Ronco C. 1951-, eds. Continuous renal replacement therapy. Oxford: Oxford University Press, 2009.

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9

Kellum, John A., Rinaldo Bellomo, and Claudio Ronco, eds. Continuous Renal Replacement Therapy. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190225537.001.0001.

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10

Kellum, John A. Continuous Renal Replacement Therapy. Oxford University Press, 2009.

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11

Acute Continuous Renal Replacement Therapy. Springer, 2012.

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12

Acute Continuous Renal Replacement Therapy. Springer, 2012.

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13

Paganini, Emil P. Acute Continuous Renal Replacement Therapy. Springer London, Limited, 2012.

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14

Karkar, Ayman, ed. Aspects in Continuous Renal Replacement Therapy. IntechOpen, 2019. http://dx.doi.org/10.5772/intechopen.76484.

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15

Bellomo, R., J. A. Kellum, G. La Manna, and C. Ronco, eds. 40 Years of Continuous Renal Replacement Therapy. S. Karger AG, 2018. http://dx.doi.org/10.1159/isbn.978-3-318-06307-3.

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16

Assadi, Farahnak, and Fatemeh Sharbaf. Pediatric Continuous Renal Replacement Therapy: Principles and Practice. Springer International Publishing AG, 2015.

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17

Assadi, Farahnak, and Fatemeh Sharbaf. Pediatric Continuous Renal Replacement Therapy: Principles and Practice. Springer, 2015.

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18

Assadi, Farahnak, and Fatemeh Sharbaf. Pediatric Continuous Renal Replacement Therapy: Principles and Practice. Springer, 2019.

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19

Marshall, Mark R. Intermittent acute renal replacement therapy. Edited by Norbert Lameire. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0233_update_001.

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This chapter summarizes current best practice with respect to intermittent haemodialysis and sustained low-efficiency dialysis (SLED) for those with acute kidney injury. These modalities can be delivered using a variety of technology platforms. These platforms for the most part use online dialysate, and water quality needs to be monitored and maintained to current standards. Intermittent haemodialysis and SLED provide reasonable outcomes in experienced hands, and ameliorate morbidity and mortality resulting from the ‘acute uraemic syndrome’: that is, intractable infection, non-resolving shock, and haemorrhage.Careful consideration needs to be given to appropriate modality selection for patients. Lower-efficiency modalities such as continuous therapies or SLED are more appropriate for patients at risk from dialysis disequilibrium syndrome, those with abdominal compartment syndrome, and those who are haemodynamically unstable (including cardiogenic shock). Care should be taken to avoid complications related to rapid fluid and solute removal, anticoagulation, and vascular access. Intradialytic hypotension is detrimental for both general and renal recovery of critically ill patients, and can be mitigated by sodium and ultrafiltration profiling, and frequent treatments and prolonged treatment time to minimize ultrafiltration goals and rates.Irrespective of the modality applied, an adequate dialysis dose must be achieved. This is facilitated through the use of optimally placed and technically superior central venous catheters, and well-considered prescription of haemodialysis and SLED operating parameters. Dose should be monitored regularly through urea kinetic modelling, either using Kt/V for thrice-weekly schedules or the corrected equivalent renal urea clearance (EKRc) for more frequent ones.

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20

Mehta, R. L. Continuous Renal Replacement Therapies Crrt: 6th International Conference on Crrt, San Diego, Calif., March 2001, Proceedings / 7th International Conference ... Diego, Calif., March (Blood Purification). S Karger Pub, 2002.

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21

Won Seo, Jang, and Ravindra L. Mehta. Renal replacement therapy in the patient with acute kidney injury. Edited by Norbert Lameire. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0232_update_001.

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Several techniques for renal replacement therapy are now utilized to manage patients with acute kidney injury including intermittent haemodialysis, continuous renal replacement therapy, sustained low-efficiency dialysis, and peritoneal dialysis. This chapter provides an update on contemporary issues including advances in dialysis technology and its effects on the application of dialysis in acute kidney injury. The timing of initiation, modality choice, optimal dose, and management of complications in dialysis are some of the areas where there is controversy.

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22

Mehta, R. L. Crrt Abstracts Collection 1995 - 2001: 1st to 6th International Conference on Continuous Renal Replacement Therapies, Sandiego, Calif. 1995-2001 (Abstracts 1995-2001: Blood Purification). S Karger Pub, 2001.

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23

Mehta, R. L. Crrt 2002 - A Multimedia Conference Compilation: Including Abstracts of the 1st to 7th International Conferences on Continuous Renal Replacement Therapies, San Diego, Calif., 1995-2002. S Karger Pub, 2002.

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24

Mehta, R. L. Crrt 2005 - a Multimedia Conference Compilation: Including Abstracts of the 1st to 10th International Conferences on Continuous Renal Replacement Therapies, San Diego, Calif., 1995-2005. Not Avail, 2005.

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25

Fichtner, Alexander, and Franz Schaefer. Acute kidney injury in children. Edited by Norbert Lameire. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0239.

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In the past few decades, the overall incidence of acute kidney injury (AKI) in paediatric patients has increased and the aetiological spectrum has shifted from infection-related and intrinsic renal causes towards secondary forms of AKI related to exposure to nephrotoxic drugs and complex surgical, oncological, and intensive care manoeuvres. In addition, neonatal kidney impairment and haemolytic uraemic syndrome continue to be important specific paediatric causes of AKI raising unique challenges regarding prevention, diagnosis, and treatment. The search for new biomarkers is a current focus of research in paediatric as in adult AKI research.Pharmacological intervention studies to prevent or attenuate AKI have provided positive evidence only for the prophylactic use of theophylline in severely depressed neonates, whereas dopamine and loop diuretics did not demonstrate any efficacy. Preliminary findings support a dose-dependent renoprotective action of fenoldopam in infants undergoing cardiac surgery.Critical issues in the management of AKI in children include fluid handling, maintenance of adequate nutrition, and the choice of renal replacement therapy modality. Observational studies have suggested an adverse impact of fluid overload and late start of renal replacement therapy, and a randomized clinical trial revealed detrimental effects of aggressive fluid bolus therapy in volume-depleted children.Technological advances have made it possible to apply continuous replacement therapies in children of all ages, including preterm neonates, using appropriately sized catheters, filters, tubing, and flow settings adapted to paediatric needs. However, the majority of children with AKI worldwide are still treated with peritoneal dialysis, and comparative studies demonstrating superiority of extracorporeal techniques over peritoneal dialysis are lacking.The outcomes of paediatric AKI are comparable to adult patients. In critically ill children, mortality risk increases with each stage of AKI; mortality rates typically range between 15% and 30% for all AKI stages and 30% to 60% in children requiring renal replacement therapy. Chronic kidney disease develops in approximately 10% of children surviving AKI.

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26

Wilson, John W., and Lynn L. Estes. Vancomycin Adult Dosing and Monitoring. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199797783.003.0017.

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(Note: Several vancomycin dosing and monitoring protocols exist; this is the one used at Mayo Clinic.)•Loading dose: Consider 20–30 mg/kg, especially in critically ill patients with serious infections such as meningitis, health care–associated pneumonia, or endocarditis.•Maintenance dose: Give 15–20 mg/kg based on actual body weight for most patients (20 mg/kg is reasonable when aiming for a trough range of 15–20 mcg/mL). Adjust based on serum levels. See also the following sections on hemodialysis and continuous renal replacement therapy....

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27

Jörres, Achim, Dietrich Hasper, and Michael Oppert. Non-dialytic management of the patient with acute kidney injury. Edited by Norbert Lameire. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0228.

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The main focus in the non-dialytic management of patients with acute kidney injury (AKI) is the prevention and treatment of complications.Nutritional support is an important aspect as many patients tend to be hypercatabolic, thus requiring adequate caloric intake, yet without administration of excessive fluid volumes. Inadequate nutrition in AKI may lead to enhanced production of urea nitrogen and azotaemia. However, hyperglycaemia is a frequent complication in these patients, often requiring continuous insulin therapy to achieve the recommended blood glucose target range of 110–150 mg/dL (6.11–8.33 mmol/L).Patients with AKI are prone to infections which are a common cause of death in this population. Careful search for and intensive treatment of infections is therefore of utmost importance, and antimicrobial chemotherapy must be initiated as early as possible, especially in patients with sepsis and AKI.Drug dosing in patients with AKI is complex and difficult. Residual kidney function can be highly variable and drug disposition may be altered due to changes in distribution volume, protein binding, and metabolism. Moreover, many drugs can be removed by renal replacement therapy (RRT). Therefore, adequate dosing must take into account the patient’s individual clinical characteristics, the specific pharmacokinetic/pharmacodynamic properties of the drug, and the mode and intensity of renal replacement therapy.

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28

Pollandt, Sebastian, and Lori Shutter. Antiseizure agents in critical illness. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0045.

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Seizures are a common problem in intensive care units (ICU) and the advent of continuous electroencephalography is demonstrating that the incidence of seizures is still underestimated. Many patients considered encephalopathic from any cause are now found to be in non-convulsive status epilepticus. While the significance of non-convulsive seizures remains unclear, there is little disagreement that these seizures should be treated with antiseizure agents and prevention of any type of seizure is a reasonable therapeutic goal. Many antiseizure agents have been studied in ICU populations and extensive experience exists with drugs such as phenytoin, valproate, or pentobarbital. Since the previous edition of this textbook, several new antiseizure agents have been introduced. Levetiracetam, topiramate, and lacosamide have been established as reasonable pharmacologic options, in particular for treatment of status epilepticus. Patients with seizures in the ICU often present with challenging clinical scenarios, which influence the choice of antiseizure agents. For example, reduced liver or renal function, especially if needing continuous renal replacement therapy or intermittent haemodialysis, has an impact on drug level variability and susceptibility to seizure development. ICU patients will typically require a multitude of pharmacological agents for their specific clinical situation and drug–drug interactions must be considered. Additionally, many medications used in ICUs are associated with seizures, in particular, certain antibiotics. Overall, the development of new drugs and better monitoring methods will undoubtedly improve our ability to control seizures in ICU patients, but currently no treatment has been shown to be universally effective for challenges, such as refractory status epilepticus.

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29

Prowle, John, and Rinaldo Bellomo. Acute kidney injury in severe sepsis. Edited by Norbert Lameire. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0244_update_001.

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Septic acute kidney injury (S-AKI) accounts for close to 50% of all cases of AKI in ICU and, in its various forms, affects between 15% and 20% of ICU patients. Patients typically present with clinical evidence of severe sepsis and septic shock, developing oliguria or anuria, and rapidly rising serum creatinine concentration. The pathophysiology of S-AKI is poorly understood. Although haemodynamic factors might play a role in the loss of glomerular filtration rate, this may not be through the induction of renal ischaemia. Inflammation, microvascular shunting, and changes in glomerular arteriolar tone may play important roles. Much evidence suggests that clinically urinalysis fails to provide useful diagnostic or prognostic information in this setting but novel biomarkers and urine microscopy may provide more useful prognostic information.The treatment of S-AKI remains based on the treatment of the aetiology of sepsis with source control and appropriate antibiotics, supportive treatment of systemic illness including, in severe cases, renal replacement therapy (RRT). Because most patients with S-AKI requiring RRT are critically ill and haemodynamically unstable, RRT in these patients is best provided as continuous RRT.Approximately 50% of patients with severe S-AKI survive to hospital discharge and, among those who survive, approximately 85–90% recover to dialysis independence. However, those patients who recover appear to be at increased risk of developing chronic kidney disease over the following years.

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