Because existing anticoagulants may have contraindications and side effects, continuous renal replacement therapy (CRRT) without anticoagulants is nevertheless widely used. Although it does not produce major adverse effects without anticoagulant CRRT, it can raise the risk of clotting, which can lead to treatment cessation. Extracorporeal circulation lines with saline flush are frequently utilized as a non-pharmaceutical anticoagulation strategy. However, in the absence of anticoagulant CRRT, its clinical efficacy remains debatable. Therefore, this article reviews the specific procedures, flushing frequency, flushing effect, and adverse events of flushing extracorporeal circulation lines with normal saline when CRRT is free anticoagulant, generating fresh ideas for future research.
Objective To explore the global research status and trends of continuous renal replacement therapy (CRRT) based on knowledge visualization analysis. Methods Based on the Web of Science Core Collection, studies reporting CRRT research that were published between June 2014 and June 2023 were retrieved and collected after manual review. VOSviewer and CiteSpace softwares were used for bibliometric visualization analysis, including publication trends, geographical distribution characteristics, journal distribution characteristics, author contributions, citations, funding source characteristics, and keyword clustering. Results A total of 2708 papers were analyzed, with an increasing trend in the number of articles and citation frequency from 2015 to 2021. The United States was the most prolific country and France was the most influential country. The University of Pittsburgh in the United States had the highest number of publications among research institutions and showed higher motivation for inter-institutional collaboration. The University of Queensland in the Australia had the highest average citation frequency. Professor Rinaldo Bellomo of Australia was the most productive author and Professor Jeffrey Lipman was the most influential. Jason A. Roberts, Jeffrey Lipman and Claudio Ronco were the three authors who had the highest number of collaborations with other authors. Keyword cluster analysis showed that the prognosis of CRRT for renal disease was the focus of research, with hotspots of research being antibiotics, citrate accumulation, plasma replacement, lactate clearance, acute respiratory distress syndrome, and coronavirus disease 2019. Coupling analysis of the literature showed that exploring the indications for CRRT and optimizing treatment prescription were at the forefront of research. Conclusions The present study of CRRT has generally shown an upward trend in the last decade. The management and efficacy of CRRT remains a hot topic of research. Exploring the indications for CRRT and optimizing treatment prescriptions may be a popular research direction and trend in the future.
ObjectiveTo explore the feasibility of pipeline blood sampling test of continuous renal replacement therapy (CRRT) when arteriovenous reversal connection occurs, and to explore the influence of pipeline blood sampling test on the results of CRRT when arteriovenous reversal connection occurs under different anticoagulation methods.MethodsSelected patients with arteriovenous reversals treated by CRRT in a third-class A hospital was selected from June 2018 to May 2019. Blood samples were collected from the front end of the CRRT pipeline (0-, 3-, and 5-min after the cease). Blood samples collected from the catheterization site were compared with those from the body vein for acid and alkali, respectively. The electrolyte and other results were analyzed and compared.ResultsA total of 80 patients were enrolled, including 40 with low molecular weight heparin and non-heparin, and 40 with citric acid. Under the anticoagulation condition of low molecular weight heparin and non-heparin, there was no difference in acid-base or electrolyte between body venous blood samples and pipeline blood samples (P>0.05). Under the anticoagulation condition of citric acid, 0-, 3-, and 5-min after the cease, the difference in free calcium between body venous blood samples and pipeline blood samples was significant (F=7.866, 6.691, 5.590, P<0.001). There was no difference in other acid-base or electrolyte results (P>0.05).ConclusionsLow molecular weight heparin and heparin-free anticoagulation can be tested by collecting blood samples from the front end of the pipeline without suspension of treatment in the case of arteriovenous reversal in CRRT. There was a difference between free calcium and body venous blood in anticoagulation with citric acid. It is not recommended to collect blood from pipes for examination Under the anticoagulationcondition of citric acid.
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.
Continuous renal replacement therapy (CRRT) is one of the important therapeutic techniques for critically ill patients. In recent years, the field of artificial intelligence has developed rapidly and has been widely applied in manufacturing, automotive, and even daily life. The development and application of artificial intelligence in the medical field are also advancing rapidly, and artificial intelligence radiographic imaging result judgment, pathological result judgment, patient prognosis prediction are gradually being used in clinical practice. The development of artificial intelligence in the field of CRRT has also made rapid progress. Therefore, this article will elaborate on the current application status of artificial intelligence in CRRT, as well as its future prospects in CRRT, so as to provide a reference for understanding the application of artificial intelligence in CRRT.
ObjectiveTo investigate the risk factors of death in patients undergoing continuous renal replacement therapy (CRRT) after cardiac surgery. MethodsWe retrospectively analyzed records of 66 adult patients without history of chronic renal failure suffering acute kidney injury (AKI) following cardiac surgery and undergoing CRRT in our hospital between July 2007 and June 2014. There were 38 males and 28 females with mean age of 59.11±12.62 years. They were divided into a survival group and a non-survival group according to prognosis at discharge. All perioperative data were collected and analyzed by univariate analysis and multivariate logistic regression analysis. ResultsIn sixty-six adult patients, eighteen patients survived with a mortality rate of 72.7%. Through univariate analysis and multivariate logistic regression, risk factors of death in the post-operative AKI patients requiring CRRT included hypotension on postoperative day 1 (B=2.897, OR=18.127, P=0.001), duration of oliguria until hemofiltration (B=0.168, OR=1.183, P=0.024), and blood platelet on postoperative day 1 (B=-0.026, OR=0.974, P=0.001). ConclusionHypotension on postoperative day 1 (POD1) is the predominant risk factor of death in patients requiring CRRT after cardiac surgery, while blood platelet on POD1 is a protective factor. If CRRT is required, the sooner the better.
ObjectiveTo observe the effect of continuous renal replacement therapy (CRRT) on serum phosphate level in patients after cardiac surgery. MethodA single-center retrospective observational study was conducted on 30 patients received CRRT after cardiac surgery. There were 14 males and 16 females with mean age of 57.0±10.8 years (ranged 37-79 years). A total of 16 patients underwent CRRT with continuous veno-venous hemofiltration (CVVH), and 14 patients with continuous veno-venous hemodiafiltration (CVVHDF). The serum phosphate level was measured before treatment, at 24 h, and 48 h during therapy and 24 h after phosphate salt supplementation. ResultsThe level of serum phosphate at 24 h and 48 h during CRRT was decreased (0.6±0.4 mmol/L vs. 0.4±0.2 mmol/L vs. 1.1±0.3 mmol/L, P<0.01). After intravenous phosphate salt supplementation, serum phosphate level got increased (0.6±0.3 mmol/L, P<0.01). There was no statistical difference in serum phosphate level between CVVH and CVVHDF (P>0.05). ConclusionHypophosphatemia occurs frequently during CRRT, particularly with long treatment time. Phosphate salt supplementation is necessary. The dosage of the supplementation should be adjusted personally based on the regularly monitoring results of serum phosphate tests.
Currently, there is a lack of guidelines and consensuses on hospital infection prevention and control for continuous renal replacement therapy (CRRT) at home and aboard. Given that in-hospital infection control for CRRT differs from that for intermittent hemodialysis, the Nephrology Brunch of Sichuan International Medical Exchange & Promotion Association, in collaboration with West China Hospital of Sichuan University, has established an expert consensus group for CRRT hospital infection prevention and control. The group conducted systematic retrieval, data analysis, and expert consultation on the thematic content, and developed five topics: occupational protection for CRRT healthcare personnel, CRRT catheter-related infections, collection of CRRT blood/waste specimens, disinfection of CRRT machines, and utilization and disposal of CRRT consumables and waste. The aim is to standardize clinical practices, prevent nosocomial infections, and enhance awareness among healthcare personnel regarding infection prevention and control in CRRT settings.
In 2017, the Acute Dialysis Quality Initiative (ADQI) Consensus Group released a series of guidelines on the topic of "Precision Continuous Renal Replacement Therapy (CRRT)". The updated content in this guideline included four parts: patient selection and timing of CRRT, precision CRRT and solute control, precision fluid management in CRRT, and role of technology for the management of AKI in critically ill patients. This review will interpret the 2017 ADQI guidelines update in detail.
Continuous renal replacement therapy (CRRT) is the treatment of choice for critically ill patients with hemodynamic instability who require renal replacement therapy. This review summarizes the impact of CRRT treatment on nutritional support in critically ill patients, including: energy increase caused by citrate-based anticoagulants, energy loss caused by glucose-free replacement fluid and dialysate, a large amount of amino acids loss in the effluent, and the influences on the way of lipid emulsion administration, capacity, electrolyte, vitamins, and trace elements. It is hoped that the intensive care unit doctors, nephrologists, and nutritionists can fully cooperate to determine the CRRT prescription and the nutritional support prescription.