Update on prescribing practices of continuous renal replacement therapy and blood purification for sepsis

doi:10.3877/cma.j.issn.2096-1537.2020.03.005

Abstract

Abstract:

Acute renal injury (AKI) is a clinically common disease. When sepsis occurs, the hospitalization time is prolonged, and it is more likely to progress to chronic kidney disease (CKD), dramatically increasing the medical cost and mortality. Continuous renal replacement therapy (CRRT) is the main form of renal replacement therapy (RRT) in intensive care unit, which has the functions of accurate and stable volume control, correction of acid-base electrolyte balance, and stabilization of hemodynamics. This review focuses on the current situation and progress of CRRT in severe AKI, sepsis, and multiple organ failure, including mode, filter, anticoagulation, prescription and dosage, vascular access, timing of start and stop, and the clinical status of blood purification for sepsis.

Key words: Acute renal injury, Sepsis, Adsorbent, Continuous renal replacement therapy, Blood purification

Jiao Liu, Minmin Wang, Yongan Liu, Hangxiang Du, Tao Wang, Lidi Zhang, Yizhu Chen, Yan Chen, Dechang Chen. Update on prescribing practices of continuous renal replacement therapy and blood purification for sepsis[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2020, 06(03): 260-266.

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References 71

1	Kramer P, Wigger W, Reiger J, et al. Arteriovenous haemofiltration: a new and simple method for treatment of overhydrated patients resistant to diuretics [J]. Klin Wochenschr, 1977, 55: 1121-1122.
2	deVeber GA. Peter Robert Uldall 1935-1995 [J]. Nephrol Dial Transplant, 1996, 11: 902-903.
3	Bellomo R, Ronco C, Mehta RL. Nomenclature for continuous renal replacement therapies [J]. Am J Kidney Dis, 1996, 28(5): S2-S7.
4	Ronco C, Ricci Z. Renal replacement therapies: physiological review [J]. Intensive Care Med, 2008, 34(12): 2139-2146.
5	Macedo E, Mehta RL. Continuous dialysis therapies: core curriculum 2016 [J]. Am J Kidney Dis, 2016, 68(4): 645-657.
6	Ronco C, 张凌, 陆任华, 等. 重症肾脏替代治疗和血液净化技术的标准化术语命名 [J]. 华西医学杂志, 2018, 33(7): 782-796.
7	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 [J]. Lancet, 2000, 356(9223): 26-30.
8	Bouman CS, Oudemans-Van Straaten HM, et al. Effects of early highvolume continuous venovenous hemofiltration on survival and recovery of renal function in intensive care patients with acute renal failure: a prospective, randomized trial [J]. Crit Care Med, 2002, 30(10): 2205-2211.
9	Tolwani AJ, Campbell RC, Stofan BS, et al. Standard versus highdose CVVHDF for ICU-related acute renal failure [J]. J Am Soc Nephrol, 2008, 19(6): 1233-1238.
10	Palevsky PM, Zhang JH, Connor TZ, et al. VA/NIH Acute Renal Failure Trial Network: intensity of renal support in critically ill patients with acute kidney injury [J]. N Engl J Med, 2008, 359(1): 7-20.
11	Bellomo R, Cass A, Cole L, et al. RENAL Replacement Therapy Study Investigators, Intensity of continuous renal-replacement therapy in critically ill patients [J]. N Engl J Med, 2009, 361(17): 1627-1638.
12	Joannes-Boyau O, Honore PM, Perez P, et al. High-volume versus standard-volume haemofiltration for septic shock patients with acute kidney injury (IVOIRE study): a multicentre randomized controlled trial [J]. Intensive Care Med, 2013, 39: 1535-1546.
13	Van Wert R, Friedrich JO, Scales DC, et al. High-dose renal replacement therapy for acute kidney injury: systematic review and meta-analysis [J]. Crit Care Med, 2010, 38(5): 1360-1369.
14	Clark E, Molnar AO, Joannes-Boyau O, et al. High-volume hemofiltration for septic acute kidney injury: a systematic review and meta-analysis [J]. Crit Care, 2014, 18(1): R7.
15	Heintz BH, Matzke GR, Dager WE. Antimicrobial dosing concepts and recommendations for critically ill adult patients receiving continuous renal replacement therapy or intermittent hemodialysis [J]. Pharmacotherapy, 2009, 29(5): 562-577.
16	Cano NJM, Aparicio M, Brunori G, et al. ESPEN guidelines on parenteral nutrition: adult renal failure [J]. Clin Nutr, 2009, 28: 401-414.
17	Van de Wetering J, Westendorp RG, Van der Hoeven JG, et al. Heparin use in continuous renal replacement procedures: the struggle between filter coagulation and patient hemorrhage [J]. J Am Soc Nephrol, 1996, 7(1): 145-150.
18	Kindgen-Milles D, Brandenburger T, Dimski T. Regional citrate anticoagulation for continuous renal replacement therapy [J]. Curr Opin Crit Care, 2018, 24(6): 450-454.
19	Schneider AG, Journois D, Rimmelé T. Complications of regional citrate anticoagulation: accumulation or overload? [J]. Crit Care, 2017, 21: 281.
20	Bai M, Zhou M, He L, et al. Citrate versus heparin anticoagulation for continuous renal replacement therapy: an updated meta-analysis of RCTs [J]. ICM, 2015, 41(12): 2098-2110.
21	Borg R, Ugboma D, Walker DM, et al. Evaluating the safety and efficacy of regional citrate compared to systemic heparin as anticoagulation for continuous renal replacement therapy in critically ill patients: a service evaluation following a change in practice [J]. J Intensive Care Soc, 2017, 18(3): 184-192.
22	Kidney Disease Improving Global Outcome KDIGO. Acute kidney injury work group: KDIGO clinical practice guideline for acute kidney injury [J]. Kidney Int Suppl, 2012, 2: 1-138.
23	Zhou Y, Zhou F, Wang X, et al. Practice of Extracorporeal Therapies for Septic Acute Kidney Injury Patients in Intensive Care Units in Mainland China [J]. Blood Purif, 2019, 47(suppl 3): 1-6.
24	Joannidis M, Straaten HM. Clinical review: patency of the circuit in continuous renal replacement therapy [J]. Crit Care, 2007, 11: 218.
25	Hackbarth R, Bunchman TE, Chua AN, et al.The effect of vascular access location and size on circuit survival in pediatric continuous renal replacement therapy: a report from the PPCRRT registry [J]. Int J Artif Organs, 2007, 30(12): 1116-1121.
26	Gaudry S, Hajage D, Schortgen F, et al. Initiation strategies for renal-replacement therapy in the intensive care unit [J]. N Engl J Med, 2016, 375: 122-133.
27	Zarbock A, Kellum JA, Schmidt C, et al. Effect of early vs delayed initiation of renal replacement therapy on mortality in critically Ill patientswith acute kidney injury: the ELAIN randomized clinical trial [J]. JAMA, 2016, 315(20): 2190-2199.
28	Yang X, Tu W, Zheng JL, et al. A comparison of early versus late initiation of renal replacement therapy for acute kidney injury in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials [J]. BMC Nephrol, 2017, 18: 264.
29	Lai TS, Shiao CC, Wang JJ, et al. Earlier versus later initiation of renal replacement therapy among critically ill patients with acute kidney injury: a systematic review and meta-analysis of randomized controlled trials [J]. Ann Intensive Care, 2017, 7: 38.
30	Zou H, Hong Q, Gaosi XU. Early versus late initiation of renal replacement therapy impacts mortality in patients with acute kidney injury post cardiac surgery: a meta-analysis [J]. Crit Care, 2017, 21: 150.
31	Barbar SD, Clere-Jehl R, Bourredjem A, et al. for the IDEAL-ICU trial investigators and the CRICS TRIGGERSEP network. Timing of renal-replacement therapy in patients with acute kidney injury and sepsis [J]. N Engl J Med, 2018, 379: 1431-1442.
32	Fayad AI, Buamscha DG, Ciapponi A. Timing of renal replacement therapy initiation for acute kidney injury [J]. Cochrane Syst Rev, 2018, 12: 10612.
33	Ostermann M, Joannidis M, Pani A, et al. 17th acute disease quality initiative (ADQI) Consensus Group: patient selection and timing of continuous renal replacement therapy [J]. Blood Purif, 2016, 42: 224-237.
34	Viallet N, Brunot V, Kuster N, et al. Daily urinary creatinine predicts the weaning of renal replacement therapy in ICU acute kidney injury patients [J]. Ann Intensive Care, 2016, 6: 71.
35	Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3) [J]. JAMA, 2016, 315: 801-810.
36	van Vught LA, Klein Klouwenberg PM, Spitoni C, et al. Incidence, risk factors, and attributable mortality of secondary infections in the intensive care unit after admission for sepsis [J]. JAMA, 2016, 315: 1469-1479.
37	Padkin A, Goldfrad C, Brady AR, et al. Epidemiology of severe sepsis occurring in the first 24 h in intensive care units in England, Wales, and Northern Ireland [J]. Crit Care Med, 2003, 31: 2332-2338.
38	Mayr FB, Yende S, Linde-Zwirble WT, et al. Infection rate and acute organ dysfunction risk as explanations for racial differences in severe sepsis [J]. JAMA, 2010, 303(24): 2495-2503.
39	Mehta RL, Bouchard J, Soroko SB, et al. Sepsis as a cause and consequence of acute kidney injury: program to improve care in acute renal disease[J]. Intensive Care Med, 2011, 37: 241-248.
40	Bellomoa R, Ramanb J, Ronco C. Intensive care unit management of the critically ill patient with fluid overload after open heart surgery[J]. Cardiology, 2001, 96: 169-176.
41	Ronco C. Evolution of technology for continuous renal replacement therapy: forty years of continuous renal replacement therapy[J]. Contrib Nephrol, 2018,194: 1-14.
42	Pinsky MR, Vincent JL, Deviere J, et al. Serum cytokine levels in human septic shock. Relation to multiple-system organ failure and mortality [J]. Chest,1993, 103: 565-575.
43	Marshall JC. Endotoxin in the pathogenesis of sepsis [J]. Contrib Nephrol. 2010, 167: 1-13.
44	Mera S, Tatulescu D, Cismaru C, et al. Multiplex cytokine profiling in patients with sepsis [J]. APMIS, 2011, 119: 155-163.
45	Oberholzer A, Souza SM, Tschoeke SK, et al. Plasma cytokine measurements augment prognostic scores as indicators of outcome in patients with severe sepsis [J]. Shock, 2005, 23: 488-493.
46	Ronco C, Tetta C, Mariano F, et al. Interpreting the mechanisms of continuous renal replacement therapy in sepsis: the peak concentration hypothesis [J]. Artif Organs, 2003, 27(9): 792-801.
47	Zhou F, Peng Z, Murugan R, Kellum JA. Blood purification and mortality in sepsis: a meta-analysis of randomized trials [J]. Crit Care Med, 2013, 41: 2209-2220.
48	Lee CT, Tu YK, Yeh YC, et al. Effects of polymyxin B hemoperfusion on hemodynamics and prognosis in septic shock patients [J]. J Crit Care, 2018, 43: 202-206.
49	Klein DJ, Foster D, Walker PM, et al. Polymyxin B hemoperfusion in endotoxemic septic shock patients without extreme endotoxemia: a post hoc analysis of the EUPHRATES trial [J]. Intensive Care Med, 2018, 44: 2205-2212.
50	Fujii T, Ganeko R, Kataoka Y, et al. Polymyxin B-immobilized hemoperfusion and mortality in critically ill adult patients with sepsis/septic shock: a systematic review with meta-analysis and trial sequential analysis [J]. Intensive Care Med, 2018, 44: 167-178.
51	Friesecke S, Stecher SS, Gross S, et al. Extracorporeal cytokine elimination as rescue therapy in refractory septic shock: a prospective single-center study [J]. J Artif Organs, 2017, 20: 252-259.
52	Schadler D, Pausch C, Heise D, et al. The effect of a novel extracorporeal cytokine hemoadsorption device on IL-6 elimination in septic patients: a randomized controlled trial [J]. PLoS One, 2017, 12: e0187015.
53	Zuccari S, Damiani E, Domizi R, et al. Changes in cytokines, haemodynamics and microcirculation in patients with sepsis/septic shock undergoing continuous renal replacement therapy and blood purification with CytoSorb [J]. Blood Purif, 2020, 49: 107-113.
54	Haase M, Silvester W, Uchino S, et al. A pilot study of high-adsorption hemofiltration in human septic shock [J]. Int J Artif Organs, 2007, 30: 108-117.
55	Shiga H, Hirasawa H, Nishida O, et al. Continuous hemodiafiltration with a cytokine-adsorbing hemofilter in patients with septic shock: a preliminary report [J]. Blood Purif, 2014, 38: 211-218.
56	Doi K, Iwagami M, Yoshida E, et al. Associations of polyethylenimine-coated AN69ST membrane in continuous renal replacement therapy with the intensive care outcomes: observations from a claims database from Japan [J]. Blood Purif, 2017, 44: 184-192.
57	Monard C, Rimmele T, Ronco C. Extracorporeal therapies for sepsis [J]. Blood Purif, 2019, 47(suppl 3): 2-15.
58	Malard B, Lambert C, Kellum JA. In vitro comparison of the adsorption of inflammatory mediators by blood purification devices [J]. Intensive Care Med Exp, 2018, 6(1): 12.
59	Shum HP, Chan KC, Kwan MC, et al. Application of endotoxin and cytokine adsorption haemofilter in septic acute kidney injury due to Gram-negative bacterial infection [J]. Hong Kong Med J, 2013, 19: 491-497.
60	Turani F, Belli AB, Martni SM, et al. Oxiris membrane decreases endotoxin during RRT in septic patients with basal EAA>0.6[A] [J]. Crit Care, 2016, 20(Suppl 2): P196.
61	Victor Schwindenhammer, Thibaut Girardot, et al. oXiris® use in septic shock: Experience of two French centres [J]. Blood Purif, 2019, 47(suppl 3): 1-7.
62	Zhang L, Tang GKY, Liu S, et al. Hemofilter with adsorptive capabilities: case report series [J]. Blood Purif, 2019, 47(suppl 3): 45-50.
63	张春, 孙博睿, 林婷等. oXiris滤器在脓毒性休克治疗中的应用:来自单中心的经验 [J]. 中华危重病急救医学, 2019, 31(12): 1531-1534.
64	Turani F, Barchetta R, Falco M, et al. Continuous renal replacement therapy with the adsorbing filter oXiris in septic patients: a case series [J]. Blood Purif, 2019, 47(suppl 3): 54-58.
65	Broman ME, Hansson F, Vincent JL, et al. Endotoxin and cytokine reducing properties of the oXiris membrane in patients with septic shock: a randomized crossover double-blind study [J]. PLoS One, 2019, 14(8): e0220444.
66	Ma J, Xia P, Zhou YZ, et al. Potential effect of blood purification therapy in reducing cytokine storm as a late complication of critically ill COVID-19 [J]. Clin Immunol, 2020, 214: 108408.
67	Yang Y, Shi J, Ge SW, et al. Effect of continuous renal replacement therapy on all-cause mortality in COVID-19 patients undergoing invasive mechanical ventilation: a retrospective cohort study[2020-05-01]. URL
68	刘娇, 周昱, 王敏敏, 等. 连续性肾脏替代治疗在新型冠状病毒肺炎中的应用[J]. 中华危重病急救医学, 2020, 32(5): 618-621.
69	杨向红, 孙仁华, 赵鸣雁, 等. 重症新型冠状病毒肺炎患者血液净化治疗流程的专家建议 [J]. 中华医学杂志, 2020,100.
70	中国医师协会肾脏内科医师分会. 新型冠状病毒肺炎合并肾损伤的预防和诊治专家建议 [J/OL] . 中华医学杂志, 2020, 100 (2020-06-15). DOI: 10.3760/cma.j.cn112137-20200525-01652.[网络预发表]. URL
71	中华医学会肾脏病学分会, 中国研究型医院学会肾脏病学专业委员会. 特殊血液净化技术应用于重症新型冠状病毒肺炎的专家共识 [J/OL] . 中华内科杂志,2020,59 (2020-06-10).DOI: 10.3760/cma.j.cn112138-20200306-00202.[网络预发表]. URL

特征	多黏菌素B吸附柱	CytoSorb吸附柱	HA330/380吸附柱	Oxiris滤器
吸附材质	多黏菌素B固定聚苯乙烯衍生纤维	聚苯乙烯二乙烯苯共聚微粒	苯乙烯-二乙烯苯共聚微粒	AN69强化多层线性PEI阳离子聚合物处理及肝素预嫁接
结构	编织纤维	微孔珠	中性大孔树脂	对称结构中空纤维
消毒方式	高压蒸汽	伽马射线	高压蒸汽	ETO环氧乙烷
吸附谱	内毒素	细胞因子	细胞因子	内毒素、细胞因子
吸附模式	离子和疏水作用力	疏水作用力	范德华及疏水作用力	离子作用力
肝素预嫁接	无	无	无	肝素预嫁接具抗血栓功能
CRRT功能	无	无	无	有

特征	多黏菌素B吸附柱	CytoSorb吸附柱	HA330/380吸附柱	Oxiris滤器
吸附材质	多黏菌素B固定聚苯乙烯衍生纤维	聚苯乙烯二乙烯苯共聚微粒	苯乙烯-二乙烯苯共聚微粒	AN69强化多层线性PEI阳离子聚合物处理及肝素预嫁接
结构	编织纤维	微孔珠	中性大孔树脂	对称结构中空纤维
消毒方式	高压蒸汽	伽马射线	高压蒸汽	ETO环氧乙烷
吸附谱	内毒素	细胞因子	细胞因子	内毒素、细胞因子
吸附模式	离子和疏水作用力	疏水作用力	范德华及疏水作用力	离子作用力
肝素预嫁接	无	无	无	肝素预嫁接具抗血栓功能
CRRT功能	无	无	无	有

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