Current applications of ultrafiltration and its impact on prognosis of critically ill patients undergoing continuous renal replacement therapy

doi:10.3877/cma.j.issn.2096-1537.2023.03.007

Abstract

Abstract:

Fluid management is one of the key components of the management of critically ill patients. Fluid overload in critically ill patients has a strong adverse impact on prognosis. Nowadays, ultrafiltration has been used for fluid removal in critically ill patients. Studies have shown that the net ultrafiltration rate is related to the prognosis of critically ill patients, however, there is still no consensus on the best net ultrafiltration rate. This article focuses on the concept and mechanism of ultrafiltration, the application of ultrafiltration for volume management, the relationship between net ultrafiltration rate and prognosis, and the application of ultrafiltration in different diseases.

Key words: Continous renal replacement theraphy, Ultrafiltration, Fluid management

Chenlong Zhao, Jin Lin, Xiaojun Ji, Meili Duan. Current applications of ultrafiltration and its impact on prognosis of critically ill patients undergoing continuous renal replacement therapy[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2023, 09(03): 274-279.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2023.03.007

https://icu.cma-cmc.com.cn/EN/Y2023/V09/I03/274

Figures/Tables 1

References 47

1	Levy MM, Artigas A, Phillips GS, et al. Outcomes of the Surviving Sepsis Campaign in intensive care units in the USA and Europe: a prospective cohort study [J]. Lancet Infect Dis, 2012, 12(12): 919-924.
2	Claure-Del GR, Mehta RL. Fluid overload in the ICU: evaluation and management [J]. BMC Nephrol, 2016, 17(1): 109.
3	Van BW, Yegenaga I, Vanholder R, et al. Relationship between fluid status and its management on acute renal failure in intensive care unit patients with sepsis: a prospective analysis [J]. J Nephrol, 2005, 18(1): 54-60.
4	Bouchard J, Soroko SB, Chertow GM, et al. Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury [J]. Kidney Int, 2009, 76(4): 422-427.
5	Boyd JH, Forbes J, Nakada TA, et al. Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality [J]. Crit Care Med, 2011, 39(2): 259-265.
6	Joannidis M, Druml W, Forni LG, et al. Prevention of acute kidney injury and protection of renal function in the intensive care unit: update2017: expert opinion of the Working Group on Prevention, AKI section, European Society of Intensive Care Medicine [J]. Intensive Care Med, 2017, 43 (6): 730-749.
7	Murugan R, Ostermann M, Peng Z, et al. Net ultrafiltration prescription and practice among critically ill patients receiving renal replacement therapy: a multinational survey of critical care practitioners [J]. Crit Care Med, 2020, 48(2): e87-97.
8	Alwall N. On the artificial kidney; apparatus for dialysis of the blood in vivo [J]. Acta Med Scand, 1947, 128(4): 317-325.
9	Ronco C, Ghezzi PM, Brendolan A, et al. The haemodialysis system: basic mechanisms of water and solute transport in extracorporeal renal replacement therapies [J]. Nephrol Dial Transplant, 1998, 13(Suppl 6): 3-9.
10	Neri M, Villa G, Garzotto F, et al. Nomenclature for renal replacement therapy in acute kidney injury: basic principles [J]. Crit Care, 2016, 20(1): 318.
11	Ronco C, Ricci Z, Bellomo R, et al. Extracorporeal ultrafiltration for the treatment of overhydration and congestive heart failure [J]. Cardiology, 2001, 96(3-4): 155-68.
12	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, 2018, 33(7): 782-796.
13	Ronco C, Brendolan A, Feriani M, et al. A new scintigraphic method to characterize ultrafiltration in hollow fiber dialyzers [J]. Kidney Int, 1992, 41(5): 1383-1393.
14	Bellomo R, Cass A, Cole L, et al. An observational study fluid balance and patient outcomes in the randomized evaluation of normal vs. augmented level of replacement therapy trial [J]. Crit Care Med, 2012, 40(6): 1753-1760.
15	Murugan R, Hoste E, Mehta RL, et al. Precision fluid management in continuous renal replacement therapy [J]. Blood Purif, 2016, 42(3): 266-278.
16	Balakumar V, Murugan R. Kidney replacement therapy for fluid management [J]. Crit Care Clin, 2021, 37(2): 433-452.
17	Balakumar V, Murugan R, Sileanu FE, et al. Both positive and negative fluid balance may be associated with reduced long-term survival in the critically ill [J]. Crit Care Med, 2017, 45(8): e749-757.
18	Murugan R, Bellomo R, Palevsky PM, et al. Ultrafiltration in critically ill patients treated with kidney replacement therapy [J]. Nat Rev Nephrol, 2021, 17(4): 262-276.
19	Flythe JE, Curhan GC, Brunelli SM. Disentangling the ultrafiltration rate-mortality association: the respective roles of session length and weight gain [J]. Clin J Am Soc Nephrol, 2013, 8(7): 1151-1161.
20	Burton JO, Jefferies HJ, Selby NM, et al. Hemodialysis-induced repetitive myocardial injury results in global and segmental reduction in systolic cardiac function [J]. Clin J Am Soc Nephrol, 2009, 4(12): 1925-1931.
21	Murugan R, Balakumar V , Kerti SJ, et al. Net ultrafiltration intensity and mortality in critically ill patients with fluid overload [J]. Crit Care, 2018, 22(1): 223.
22	Tehranian S, Shawwa K, Kashani KB. Net ultrafiltration rate and its impact on mortality in patients with acute kidney injury receiving continuous renal replacement therapy [J]. Clin Kidney J, 2019, 14(2): 564-569.
23	Murugan R, Kerti SJ, Chang CH, et al. Association of net ultrafiltration rate with mortality among critically ill adults with acute kidney injury receiving continuous venovenous hemodiafiltration: a secondary analysis of the randomized evaluation of normal vs augmented level (RENAL) of renal replacement therapy trial [J]. JAMA Netw Open, 2019, 2(6): e195418.
24	Naorungroj T, Neto AS, Zwakman-Hessels L, et al. Early net ultrafiltration rate and mortality in critically ill patients receiving continuous renal replacement therapy [J]. Nephrol Dial Transplant, 2021, 36(6): 1112-1119.
25	Naorungroj T, Neto AS, Zwakman-Hessels L, et al. Mediators of the impact of hourly net ultrafiltration rate on mortality in critically ill patients receiving continuous renal replacement therapy [J]. Crit Care Med, 2020, 48(10) : e934-e942.
26	Flythe JE, Kimmel SE, Brunelli SM, et al. Rapid fluid removal during dialysis is associated with cardiovascular morbidity and mortality [J]. Kidney Int, 2011, 79(2): 250-257.
27	Kim TW, Chang TI, Kim TH, et al. Association of ultrafiltration rate with mortality in incident hemodialysis patients [J]. Nephron, 2018, 139(1): 13-22.
28	Saran R, Bragg-Gresham JL, Levin NW, et al. Longer treatment time and slower ultrafiltration in hemodialysis: associations with reduced mortality in the DOPPS [J]. Kidney Int, 2006, 69(7): 1222-1228.
29	Assimon MM, Wenger JB, Wang L, et al. Ultrafiltration rate and mortality in maintenance hemodialysis patients [J]. Am J Kidney Dis, 2016, 68(6): 911-922.
30	Serpa NA, Naorungroj T, Murugan R, et al. Heterogeneity of effect of net ultrafiltration rate among critically ill adults receiving continuous renal replacement therapy [J]. Blood Purif, 2021, 50(3): 336-346.
31	Ross JS, Chen J, Lin Z, et al. Recent national trends in readmission rates after heart failure hospitalization [J]. Circ Heart Fail, 2010, 3(1): 97-103.
32	Costanzo MR, Guglin ME, Saltzberg MT, et al. Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure [J]. J Am Coll Cardiol, 2007, 49(6): 675-83.
33	Bart BA, Goldsmith SR, Lee KL, et al. Ultrafiltration in decompensated heart failure with cardiorenal syndrome [J]. N Engl J Med, 2012, 367(24): 2296-2304.
34	Costanzo MR, Negoianu D, Jaski BE, et al. Aquapheresis versus intravenous diuretics and hospitalizations for heart failure [J]. JACC Heart Fail, 2016, 4(2): 95-105.
35	Marenzi G, Muratori M, Cosentino ER, et al. Continuous ultrafiltration for congestive heart failure: the CUORE Trial [J]. J Card Fail, 2014, 20(1): 9-17.
36	Wobbe B, Wagner J, Szabó DK, et al. Ultrafiltration is better than diuretic therapy for volume-overloaded acute heart failure patients: a meta-analysis [J]. Heart Fail Rev, 2021, 26(3): 577-585.
37	Mao H, Katz N, Ariyanon W, et al. Cardiac surgery-associated acute kidney injury [J]. Blood Purif, 2014, 37(suppl 2): 34-50.
38	Vandenberghe W, Gevaert S, Kellum JA, et al. Acute kidney injury in cardiorenal syndrome type 1 patients: a systematic review and meta-analysis [J]. Cardiorenal Med, 2016, 6(2): 116-128.
39	Machado MN, Nakazone MA, Maia LN. Prognostic value of acute kidney injury after cardiac surgery according to Kidney Disease: Improving Global Outcomes definition and staging (KDIGO) criteria [J]. PLoS One, 2014, 9(5): e98028.
40	Koc V, Delmas BL, de With E, et al. The effect of fluid overload on attributable morbidity after cardiac surgery: a retrospective study [J]. Crit Care Res Pract, 2020, 2020: 4836862.
41	Wu B, Sun J, Liu S, et al. Relationship among mortality of patients with acute kidney injury after cardiac surgery, fluid balance and ultrafiltration of renal replacement therapy: an observational study [J]. Blood Purif, 2017, 44(1): 32-39.
42	Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016 [J]. Intensive Care Med, 2017, 43(3): 304-377.
43	Acheampong A, Vincent JL. A positive fluid balance is an independent prognostic factor in patients with sepsis [J]. Crit Care, 2015, 19(1): 251.
44	de Oliveira FS, Freitas FG, Ferreira EM, et al. Positive fluid balance as a prognostic factor for mortality and acute kidney injury in severe sepsis and septic shock [J]. J Crit Care, 2015, 30(1): 97-101.
45	孙治平, 孙伏喜, 牛常明, 等. 连续性肾脏替代治疗及其液体负平衡可改善脓毒性急性肾损伤患者的肾功能和预后 [J]. 中华危重病急救医学, 2015, 27(5): 321-326.
46	Jhee JH, Lee HA, Kim S, et al. The interactive effects of input and output on managing fluid balance in patients with acute kidney injury requiring continuous renal replacement therapy [J]. Crit Care, 2019, 23(1): 329.
47	Ospina-Tascón GA, Hernandez G, Alvarez I, et al. Effects of very early start of norepinephrine in patients with septic shock: a propensity score-based analysis [J]. Crit Care, 2020, 24(1): 52.

文献	年份	研究对象	例数	设计	结论
Murugan等^［21］	2018	RRT前液体过负荷≥5%	1075	回顾性观察性研究	净超滤率＞25 ml/（kg•d）与较低的1年病死率相关
Tehranian等^［22］	2019	行CRRT的AKI患者	1398	回顾性队列研究	净超滤率≥35 ml/（kg•d）与较低的30 d病死率独立相关
Murugan等^［23］	2019	行CVVHDF的AKI患者	1434	回顾性观察性研究的二次分析	净超滤率＞1.75 ml/（kg•h）与90 d存活率降低有关
Naorungroj等^［24］	2021	行CRRT的危重症患者	347	回顾性观察性研究	净超滤率＞1.75 ml/（kg•h）与28 d病死率增加有关
Naorungroj等^［25］	2020	行CRRT的危重症患者	347	回顾性观察性研究	净超滤率＞1.75 ml/（kg•h）与28 d病死率增加独立相关

文献	年份	研究对象	例数	设计	结论
Murugan等^［21］	2018	RRT前液体过负荷≥5%	1075	回顾性观察性研究	净超滤率＞25 ml/（kg•d）与较低的1年病死率相关
Tehranian等^［22］	2019	行CRRT的AKI患者	1398	回顾性队列研究	净超滤率≥35 ml/（kg•d）与较低的30 d病死率独立相关
Murugan等^［23］	2019	行CVVHDF的AKI患者	1434	回顾性观察性研究的二次分析	净超滤率＞1.75 ml/（kg•h）与90 d存活率降低有关
Naorungroj等^［24］	2021	行CRRT的危重症患者	347	回顾性观察性研究	净超滤率＞1.75 ml/（kg•h）与28 d病死率增加有关
Naorungroj等^［25］	2020	行CRRT的危重症患者	347	回顾性观察性研究	净超滤率＞1.75 ml/（kg•h）与28 d病死率增加独立相关

[1]	Guanyi Cao, Quan Li, Hongyan Zhu, Shunpeng Xing. Application of pulse indicator continuous cardiac output monitoring in fluid management for patients with severe acute pancreatitis and acute respiratory distress syndrome [J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2016, 09(02): 96-100.
[2]	Zengxian Wang, Jing Wang, Shuyi Yang. Investigating the effect of goal-directed fluid management strategy on tissue perfusion and stress response in patients undergoing laparoscopic hepatectomy [J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(02): 134-138.
[3]	Yan Xu, Chongxiang He, Xin Zhou, Li Pan, Qifa Ye. The progress of post-operative fluid management improves delayed graft function in kidney transplantation [J]. Chinese Journal of Transplantation(Electronic Edition), 2021, 15(06): 370-374.
[4]	Wenjing Wang, Bo Guo, Yi Lyu, Chang Liu, Bo Wang, Zheng Wang, Xiaogang Zhang. Application of goal-directed fluid therapy in fluid management after liver transplantation [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2017, 06(04): 275-279.
[5]	Zhaohui Ni, Haijiao Jin. Strategy of diagnosis and treatment for ultrafiltration failure of peritoneal dialysis [J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2016, 05(03): 97-100.
[6]	Ying Sun, Qian Zhai. Fluid management in patients with severe COVID-19 [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2020, 06(03): 335-338.
[7]	Xianghong Yang, Lina Zhang, Bo Hu, Ruiqiang Zheng, Qian Zhai, Wenkui Yu, Yun Long, Critical Care County Working Group. Protocolized care for continuous renal replacement theraphy [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2019, 05(01): 27-31.
[8]	Qingwen Sun, Bifang Xie, Weibo Liang, Yuanda Xu, Yimin Li. Hemodynamic management in acute respiratory distress syndrome: focus on fluid management [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2016, 02(04): 291-296.

Please choose a citation manager

Content to export