An Innovative Approach to Minimizing Downtime in Continuous Kidney Replacement Therapy.
Journal
ASAIO journal (American Society for Artificial Internal Organs : 1992)
ISSN: 1538-943X
Titre abrégé: ASAIO J
Pays: United States
ID NLM: 9204109
Informations de publication
Date de publication:
01 06 2023
01 06 2023
Historique:
medline:
5
6
2023
pubmed:
29
3
2023
entrez:
28
3
2023
Statut:
ppublish
Résumé
Continuous kidney replacement therapy (CKRT) is often utilized to stabilize patients with severe acute kidney injury associated with significant electrolyte abnormalities and/or oliguria and concomitant fluid accumulation. Circuit downtime may reduce daily treatment time and affect delivered doses of CKRT. Studies have found clotting to be the leading cause of downtime and underdosing, which are associated with negative treatment outcomes. The NxStage Cartridge Express with Speedswap (NxStage Medical, Inc.) was designed to minimize downtime by allowing filter priming to occur in parallel with ongoing CKRT and by permitting filter exchanges without the need to replace the entire cartridge. Data from pilot studies suggest that filter exchanges using this system interrupt treatment by an average of 4 minutes per exchange-a considerable reduction from traditional systems that require treatment to be discontinued while the filter is primed, which can take 30 minutes or more. In addition to increasing patient time on therapy, this system has the potential to reduce costs for patients who require a high number of filter changes, and reduce nursing labor and environmental impact (reduced plastic waste). Future studies should confirm whether patients at higher risk of clotted/clogged filters benefit from CKRT with a system designed for rapid filter changes.
Identifiants
pubmed: 36976305
doi: 10.1097/MAT.0000000000001928
pii: 00002480-202306000-00022
pmc: PMC10226470
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e250-e255Informations de copyright
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the ASAIO.
Références
Tandukar S, Palevsky PM: Continuous renal replacement therapy: Who, when, why, and how. Chest 155: 626–638, 2019.
Tolwani A: Continuous renal-replacement therapy for acute kidney injury. N Engl J Med 367: 2505–2514, 2012.
Mehta RL, Pascual MT, Soroko S, et al.; Program to Improve Care in Acute Renal Disease: Spectrum of acute renal failure in the intensive care unit: The PICARD experience. Kidney Int 66: 1613–1621, 2004.
Uchino S, Kellum JA, Bellomo R, et al.; Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators: Acute renal failure in critically ill patients: A multinational, multicenter study. JAMA 294: 813–818, 2005.
Brown JR, Rezaee ME, Marshall EJ, Matheny ME: Hospital mortality in the United States following acute kidney injury. Biomed Res Int 2016: 4278579, 2016.
Hsu RK, McCulloch CE, Dudley RA, Lo LJ, Hsu CY: Temporal changes in incidence of dialysis-requiring AKI. J Am Soc Nephrol 24: 37–42, 2013.
Garnier F, Couchoud C, Landais P, Moranne O: Increased incidence of acute kidney injury requiring dialysis in metropolitan France. PLoS One 14: e0211541, 2019.
Stack AG, Li X, Kaballo MA, et al.: Temporal trends in acute kidney injury across health care settings in the Irish health system: A cohort study. Nephrol Dial Transplant 35: 447–457, 2020.
Kellum JA, Lameire N, Aspelin P, et al.: Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2: 1–138, 2012.
Vásquez Jiménez E, Anumudu SJ, Neyra JA: Dose of continuous renal replacement therapy in critically ill patients: A bona fide quality indicator. Nephron 145: 91–98, 2021.
Uchino S, Bellomo R, Morimatsu H, et al.: Continuous renal replacement therapy: A worldwide practice survey. The Beginning and Ending Supportive Therapy for the Kidney (B.E.S.T. Kidney) Investigators. Intensive Care Med 33: 1563–1570, 2007.
Ronco C, Bellomo R, Homel P, et al.: Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: A prospective randomised trial. Lancet 356: 26–30, 2000.
Rewa OG, Tolwani A, Mottes T, et al.; ADQI Consensus Meeting Members on behalf of ADQI XXII: Quality of care and safety measures of acute renal replacement therapy: Workgroup statements from the 22nd acute disease quality initiative (ADQI) consensus conference. J Crit Care 54: 52–57, 2019.
Mottes TA, Goldstein SL, Basu RK: Process based quality improvement using a continuous renal replacement therapy dashboard. BMC Nephrol 20: 17, 2019.
Uchino S, Fealy N, Baldwin I, Morimatsu H, Bellomo R: Continuous is not continuous: The incidence and impact of circuit “down-time” on uraemic control during continuous veno-venous haemofiltration. Intensive Care Med 29: 575–578, 2003.
Mehta RL, McDonald B, Gabbai FB, et al.; Collaborative Group for Treatment of ARF in the ICU: A randomized clinical trial of continuous versus intermittent dialysis for acute renal failure. Kidney Int 60: 1154–1163, 2001.
Venkataraman R, Kellum JA, Palevsky P: Dosing patterns for continuous renal replacement therapy at a large academic medical center in the United States. J Crit Care 17: 246–250, 2002.
Gardner L: Does nurse management effect continuous renal replacement downtime? Master’s Theses, Dissertations, Graduate Research and Major Papers Overview. 300. 2019. Available at: https://digitalcommons.ric.edu/etd/300/ . Accessed June 1, 2022.
Rewa O, Villeneuve PM, Eurich DT, et al.: Quality indicators in continuous renal replacement therapy (CRRT) care in critically ill patients: Protocol for a systematic review. Syst Rev 4: 102, 2015.
Villa G, Neri M, Ronco C, Cerdá J: Prescription and delivery of the right continuous renal replacement therapies dose. Contrib Nephrol 194: 38–50, 2018.
Cortina G, McRae R, Chiletti R, Butt W: The effect of patient- and treatment-related factors on circuit lifespan during continuous renal replacement therapy in critically ill children. Pediatr Crit Care Med 21: 578–585, 2020.
Ahmed AR, Obilana A, Lappin D: Renal replacement therapy in the critical care setting. Crit Care Res Pract 2019: 6948710, 2019.
Bai M, Zhou M, He L, et al.: Citrate versus heparin anticoagulation for continuous renal replacement therapy: An updated meta-analysis of RCTs. Intensive Care Med 41: 2098–2110, 2015.
Zarbock A, Küllmar M, Kindgen-Milles D, et al.; RICH Investigators and the Sepnet Trial Group: Effect of regional citrate anticoagulation vs systemic heparin anticoagulation during continuous kidney replacement therapy on dialysis filter life span and mortality among critically ill patients with acute kidney injury: A randomized clinical trial. JAMA 324: 1629–1639, 2020.
Morabito S, Pistolesi V, Tritapepe L, et al.: Regional citrate anticoagulation in cardiac surgery patients at high risk of bleeding: A continuous veno-venous hemofiltration protocol with a low concentration citrate solution. Crit Care 16: R111, 2012.
Zhang W, Bai M, Zhang L, et al.: Development and external validation of a model for predicting sufficient filter lifespan in anticoagulation-free continuous renal replacement therapy patients. Blood Purif 51: 668–678, 2022.
Brain M, Winson E, Roodenburg O, McNeil J: Non anti-coagulant factors associated with filter life in continuous renal replacement therapy (CRRT): A systematic review and meta-analysis. BMC Nephrol 18: 69, 2017.
Endres P, Rosovsky R, Zhao S, et al.: Filter clotting with continuous renal replacement therapy in COVID-19. J Thromb Thrombolysis 51: 966–970, 2021.
Legouis D, Montalbano MF, Siegenthaler N, et al.: Decreased CRRT filter lifespan in COVID-19 ICU patients. J Clin Med 10: 1873, 2021.
Valle EO, Cabrera CPS, Albuquerque CCC, et al.: Continuous renal replacement therapy in COVID-19–associated AKI: Adding heparin to citrate to extend filter life—a retrospective cohort study. Crit Care 25: 299, 2021.
Davenport A, Honore PM: Continuous renal replacement therapy under special conditions like sepsis, burn, cardiac failure, neurotrauma, and liver failure. Semin Dial 34: 457–471, 2021.
Duan Z, Cai G, Li J, Chen F, Chen X: Meta-analysis of renal replacement therapy for burn patients: Incidence rate, mortality, and renal outcome. Front Med (Lausanne) 8: 708533, 2021.
Polaschegg HD: The extracorporeal circuit. Semin Dial 8: 299–304, 1995.
Hatamizadeh P, Tolwani A, Palevsky P: Revisiting filtration fraction as an index of the risk of hemofilter clotting in continuous venovenous hemofiltration. Clin J Am Soc Nephrol 15: 1660–1662, 2020.
Cerdá J, Baldwin I, Honore PM, Villa G, Kellum JA, Ronco C; ADQI Consensus Group: Role of technology for the management of AKI in critically ill patients: From adoptive technology to precision continuous renal replacement therapy. Blood Purif 42: 248–265, 2016.
Krieter DH, Morgenroth A, Barasinski A, et al.: Effects of a polyelectrolyte additive on the selective dialysis membrane permeability for low-molecular-weight proteins. Nephrol Dial Transplant 22: 491–499, 2007.
von Harten B: Membranes and filters for renal replacement therapies: Basic technology and descriptions (part 1). Wuppertal, Germany, Membrana GmbH. Webinar presented February 9, 2010. Available at: https://www.nxstage.com/hcp/training-resources/membranes-and-filters-for-renal-replacement-therapies-1/ . Accessed June 1, 2022.
Krieter DH, Lemke HD, Wanner C: A new synthetic dialyzer with advanced permselectivity for enhanced low-molecular weight protein removal. Artif Organs 32: 547–554, 2008.
NxStage System One Critical Care User Guide. NC4921 Rev. K. Lawrence, MA, NxStage Medical, Inc., October 2021.