Objective To evaluate the efficacy and safety of in vitro anticoagulation with nafamostat mesilate in continuous renal replacement therapy (CRRT) in patients with sepsis complicated with acute kidney injury (AKI). Methods The study subjects were sepsis patients with AKI who underwent CRRT in West China Hospital of Sichuan University and were at high risk of bleeding. CRRT patients who received in vitro anticoagulation with nafamostat mesilate between July 2021 and January 2022 were included in the nafamostat group. The medical records of CRRT patients who did not use anticoagulants between January 2020 and December 2020 were retrospectively collected as a control group. The general situation, the lifespan of the first CRRT filter, the number of filters used within 72 hours of treatment, laboratory tests before and after treatment, and the occurrence of adverse reactions during treatment of the two groups of patients were analyzed. Results There were 42 patients in the control group and 21 patients in the nafamostat group. There was no statistically significant difference in age, gender, body mass index, mean arterial pressure, primary disease, Sequential Organ Failure Assessment score, Acute Physiology and Chronic Health Evaluation Ⅱ score, or pre-treatment laboratory test results between the two groups of patients (P>0.05). Kaplan-Meier survival analysis showed that the lifespan of the first filter was longer in the nafamostat group than in the control group (hazard ratio=0.408, P<0.05). The number of filters used by the control group patients after 72 hours of treatment was greater than that of the nafamostat group patients (2.1±0.6 vs. 1.3±0.5, P<0.05). After 72 hours of treatment, serum creatinine levels [(99.4±15.7) vs. (127.6±20.5)] μmol/L], urea nitrogen [(4.5±1.9) vs. (6.8±2.3) mmol/L], cystatin C [(1.0±0.2) vs. (1.2±0.2) mg/L], uric acid [(86.5±15.3) vs. (105.3±20.3) μmol/L] in the nafamostat group were lower than those of the control group (P<0.05), and there was no statistically significant difference in the results of other laboratory tests (P>0.05). There was no statistically significant difference in adverse reactions between the two groups of patients (P>0.05). Conclusion For patients with sepsis complicated with AKI who undergo CRRT and are at high risk of bleeding, nafamostat mesilate may be a safe and effective anticoagulant for in vitro anticoagulation.
Continuous renal replacement therapy (CRRT) originated from intermittent hemodialysis. Over the past 40 years, its application scope has gradually expanded from the initial treatment of kidney diseases alone to the support of multi-organ functions. As a safe, adequate, and flexible therapeutic modality, CRRT has become one of the main means of treating critically ill patients. Continuous innovation in technology, biomaterials and other technologies provides important driving force for the sustainable development of CRRT. This paper reviews the technological innovation and development of CRRT devices. With continuous technological updates and iteration, CRRT can better adapt to clinical needs. Biofeedback, portability, and intelligence are several directions of the development of CRRT, which can provide more accurate and personalized treatment for critically ill patients in different scenarios.
With chronic kidney disease becoming a public health problem in the world, dialysis treatment model has also become the focus of attention from all walks of life. Sustained low-efficiency dialysis, which adopts the mode of low blood flow and low dialysis volume, is a kind of hybrid renal replacement therapy combining continuous renal replacement therapy and intermittent hemodialysis. It has unique advantages in the treatment of patients with acute and severe renal injury, as well as the dialysis duration, patient activity range and cost. It is the most widely used hybrid renal replacement therapy too. This review summarizes the clinical application and nursing points of sustained low-efficiency dialysis to provide guidance for clinical practice.
Continuous renal replacement therapy (CRRT) is an important therapy for patients with severe acute kidney injury. With the development of blood purification, the application of CRRT has been beyond the scope of kidney disease and developed into a comprehensive and integrated organ support platform, providing a hybrid treatment of different blood purification techniques. With the advancement of informatization, it is possible to improve the quality of CRRT treatment to formulate individualized and precise treatment based on the specific information of patients. This article will discuss the precise prescription and development prospective of CRRT from three dimensions: anticoagulation, dosage and volume management.
ObjectiveTo explore the effect of continuous renal replacement therapy (CRRT) to treat sepsis associated acute kidney injury (AKI) in patients aged over 80.MethodsForty-one patients diagnosed with sepsis and AKI were enrolled in geriatric RICU department of Huadong Hospital from January 2013 to July 2018, 38 patients were male and 3 were female. All patients were treated with anti-infection and fluid resuscitation therapy. After comprehensive judgment of the indication of renal replacement, they were divided into two groups by the choices of using CRRT. There were 20 patients in CRRT group and 21 in control group. Clinical data such as age, body mass index, previous diseases, 28-day mortality rate, blood cells, APACHEⅡ as well as SOFA scores were compared between two groups. Blood renal function and inflammatory markers at the first day were also compared to those after 3-day treatment of initial time.ResultsNo statistical difference was observed in sex ratio, age, body mass index and previous diseases between two groups (all P>0.05). There was also no difference in APACHEⅡ score, SOFA score, blood cells, hemoglobin and survival time. The 28-day mortality rate in CRRT group was lower than that in control group (P<0.05). The levels of serum UA and C reactive protein (CRP) in CRRT group decreased after 3-day treatment compared with those at the onset, and the differences were statistically significant (all P<0.05). The level of serum blood urea nitrogen (BUN), creatinine (Cr), uric acid (UA) and cystain C in control group increased after 3 days compared with those at the onset, and the difference were statistically significant (all P<0.05). There was no significant difference in serum BUN, Cr, UA, cystain C, CRP and procalcitonin (PCT) between two groups at the onset (all P>0.05). After 3 days of CRRT, the levels of serum PCT, BUN, Cr and UA in CRRT group were lower than those in the control group (all P<0.05).ConclusionCRRT can improve hyperuricemia, control deterioration of renal function, reduce early systemic inflammatory response and 28-day mortality rate in aged patients with sepsis and AKI.
Most patients with coronavirus disease 2019 (COVID-19) have a good prognosis, but a certain proportion of the elderly and people with underlying diseases are still prone to develop into severe and critical COVID-19. Kidney is one of the common target organs of COVID-19. Acute kidney injury (AKI) is a common complication of severe COVID-19 patients, especially critical COVID-19 patients admitted to intensive care units. AKI associated with COVID-19 is also an independent risk factor for poor prognosis in patients. This article mainly focuses on the epidemiological data, possible pathogenesis, diagnostic criteria, and prevention and treatment based on the 5R principle of AKI associated with COVID-19. It summarizes the existing evidence to explore standardized management strategies for AKI associated with COVID-19.
Continuous renal replacement therapy (CRRT) is a term of blood purification technique that can continuously remove the body's solute and water for 24 hours without any interruption throughout each day. It has several advantages such as hemodynamic stability, accurate capacity control, stable internal environment, and inflammatory regulation, which is especially suitable for patients with severe hemodynamic instability. In clinical practice, critically ill patients treated with CRRT are often associated with different types of acidosis, including metabolic acidosis, lactic acidosis, citrate acidosis, ketoacidosis and hypercapnic acidosis. Different types of acidosis can be treated in different ways. This paper reviews the CRRT for special types of acidosis.
After more than 10 years of development and construction, the continuous renal replacement therapy subspecialty of the Department of Nephrology of West China Hospital of Sichuan University has made outstanding achievements in the aspect of continuing education. This article discusses and summarizes the current training measures for continuous renal replacement therapy subspecialized refresher physicians in the Department of Nephrology of West China Hospital of Sichuan University, and introduces the training goals, training measures and training results. The purpose is to provide a summary of experience for the continuing education of continuous renal replacement therapy subspecialized refresher physicians, provide a reference for hospitals that plan to develop continuous renal replacement therapy subspecialized refresher physicians training, and assists in promoting the development of continuous renal replacement therapy subspecialized continuing education in China.
This article reviews Chinese nomenclature of renal replacement therapy and extracorporeal blood purification currently utilized to manage acute kidney injury and other organ dysfunction syndromes in critically ill patients, based on the recent reports of a consensus expert conference of Nomenclature Standardization Initiative Alliance. We provide a detailed description of the performance characteristics of membranes, filters, transmembrane transport of solutes and fluid, flows, and methods of measurement of delivered treatment, common definitions, components, techniques, and operations of the machines and platforms as well as the renal replacement therapy techniques in detail with the relevant technologies, procedures, operations, and recent developments in other extracorporeal therapies, including therapeutic plasma exchange, multiple organ support therapy, liver support, lung support, and blood purification in sepsis. We believe this nomenclature review will serve future use of terminology in publications, research, clinical operations and therapy platforms to enable consistent data collection and comparison.
Acute kidney injury is a common complication in the critically ill patients with high morbidity and mortality. Continuous renal replacement therapy (CRRT) is one of the most important treatments for the disease. The timing of starting and stopping of CRRT is often a matter of choice for clinicians. Early stopping of CRRT may lead to inadequate treatment, recurrent disease and poor prognosis, while excessive treatment of CRRT may prolong the hospital stay, increase medical costs and increase the risk of CRRT-related complications. In order to illustrate the proper stopping time of CRRT, this paper summarizes the research progress of the clinical indicators and biomarkers by reviewing relevant domestic and foreign data.