40 Years of Continuous Renal Replacement Therapy

Editor(s): Bellomo, R. (Melbourne, VIC)
Kellum, J.A. (Pittsburgh, PA)
La Manna, G. (Bologna)
Ronco, C. (Vicenza)
 

Evolution of Vascular Access and Anticoagulation

Honore P.M.a · Spapen H.D.b

Author affiliations

aProfessor of Intensive Care Medicine, Deputy Chairman of ICU Department, Director of ICU Research, Centre Hopitalier Universitaire Brugmann, Brussels, and bProfessor of Intensive Care Medicine, Director of Research Unit and ICU, ICU Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium

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Bellomo R, Kellum JA, La Manna G, Ronco C (eds): 40 Years of Continuous Renal Replacement Therapy. Contrib Nephrol. Basel, Karger, 2018, vol 194, pp 15-24
https://doi.org/10.1159/000485597

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Article / Publication Details

First-Page Preview
Abstract of  

Published online: March 29, 2018
Cover Date: 2018

Number of Print Pages: 10
Number of Figures: 2
Number of Tables: 0

ISBN: 978-3-318-06306-6 (Print)
eISBN: 978-3-318-06307-3 (Online)

Abstract

Continuous renal replacement therapy (CRRT) is an important and widely used adjuvant treatment in critically ill patients. However, any CRRT protocol can be adhered to only when the technique is correctly installed and functioning properly. Within this context, an appropriate vascular access and a safe and effective circuit anticoagulation method are key requisites. The right internal jugular (RIJ) vein is the preferred route for insertion with the tip of the catheter placed in the right atrium. Both femoral veins offer a valuable alternative access, but catheters must be longer to avoid recirculation and circuit blood flow is lower as compared with that of the RIJ approach. The location of the catheter is not associated with differences in bacterial colonization/infection rate or filter/circuit lifespan. Adequate anticoagulation is imperative to avoid a system “shutdown” due to the early clotting of the filter. For a long time, unfractionated heparin (UFH) was the anticoagulant of choice. UFH is associated with an increased bleeding risk and requires the use of high circuit blood flows. The introduction of regional citrate anticoagulation (RCA) created a paradigm change in CRRT anticoagulation. RCA can be applied safely in patients with increased bleeding risk and may enhance filter and circuit survival as compared with UFH. RCA requires close monitoring for potentially serious metabolic side effects. Future perspectives include improved catheter technology and development of novel citrate solutions with less severe metabolic impact.

© 2018 S. Karger AG, Basel



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References

  1. Honore PM (Editor-in-Chief): Renal replacement in critical care; in Honore PM, Joannes-Olivier O, Spapen HD, Bihorac A (eds): Textbook 269 pages. Lambert Academic Publishing release in February, 2016.
  2. Glazer S, Saint L, Shenoy S: How to prolong the patency of vascular access. Contrib Nephrol 2015;184:143-152.
  3. Granata A, D'Intini V, Bellomo R, Ronco C: Vascular access for acute extracorporeal renal replacement therapies. Contrib Nephrol 2004;142:159-177.
  4. Parienti JJ, Mégarbane B, Fischer MO, Lautrette A, Gazui N, Marin N, Hanouz JL, Ramakers M, Daubin C, Mira JP, Charbonneau P, du Cheyron D; Cathedia Study Group: Catheter dysfunction and dialysis performance according to vascular access among 736 critically ill adults requiring renal replacement therapy: a randomized controlled study. Crit Care Med 2010;34:1118-1125.
  5. Morgan D, Ho K, Murray C, Davies H, Louw J: A randomized trial of catheters of different lengths to achieve right atrium versus superior vena cava placement for continuous renal replacement therapy. Am J Kidney Dis 2012;60:272-279.
  6. Lameire N, Kellum JA; KDIGO AKI Guideline Work Group: Contrast-induced acute kidney injury and renal support for acute kidney injury: a KDIGO summary (part II). Crit Care 2013;17:205.
  7. Canaud B, Formet C, Raynal N, Amigues L, Klouche K, Leray-Moragues H, Béraud JJ: Vascular access for extracorporeal renal replacement therapy in the intensive care unit. Contrib Nephrol 2004;144:291-307.
  8. Parienti JJ, Thirion M, Mégarbane B, Souweine B, Ouchikhe A, Polito A, Forel JM, Marqué S, Misset B, Airapetian N, Daurel C, Mira JP, Ramakers M, du Cheyron D, Le Coutour X, Daubin C, Charbonneau P; Members of the Cathedia Study Group: Femoral vs jugular venous catheterization and risk of nosocomial events in adults requiring acute renal replacement therapy: a randomized controlled trial. JAMA 2008;299:2413-2422.
  9. Joannidis M, Oudemans-van Straaten HM: Clinical review: patency of the circuit in continuous renal replacement therapy. Crit Care 2007;11:218.
  10. Schetz M: Vascular access for HD and CRRT. Contrib Nephrol 2007;156:275-286.
  11. Baldwin I, Bellomo R: Relationship between blood flow, access catheter and circuit failure during CRRT: a practical review. Contrib Nephrol 2004;144:203-213.
  12. Parienti JJ, Deryckère S, Mégarbane B, Valette X, Seguin A, Sauneuf B, Mira JP, Souweine B, Cattoir V, Daubin C, du Cheyron D; Cathedia Study Group: Quasi-experimental study of sodium citrate locks and the risk of acute hemodialysis catheter infection among critically ill patients. Antimicrob Agents Chemother 2014;58:5666-5672.
  13. Mehta RL, McDonald BR, Aguilar MM, Ward DM: Regional citrate anticoagulation for continuous arteriovenous hemodialysis in critically ill patients. Kidney Int 1990;38:976-981.
  14. Mehta RL, McDonald BR, Ward DM: Regional citrate anticoagulation for continuous arteriovenous hemodialysis. An update after 12 months. Contrib Nephrol 1991;93:210-214.
  15. Jacobs R, Honoré PM, Bagshaw SM, Diltoer M, Spapen HD: Citrate formulation determines filter lifespan during continuous veno-venous hemofiltration: a prospective cohort study. Blood Purif 2015;40:194-202.
  16. Gainza FJ, Quintanilla N, Pijoan JI, Delgado S, Urbizu JM, Lampreabe I: Role of prostacyclin (epoprostenol) as anticoagulant in continuous renal replacement therapies: efficacy, security and cost analysis. J Nephrol 2006;19:648-655.
  17. Jacobs R, Honore PM, Hendrickx I, Spapen HD: Regional citrate anticoagulation for continuous renal replacement therapy: all citrates are not created equal! Blood Purif 2016;42:219-220.
  18. Oudemans-van Straaten HM, Ostermann M: Bench-to-bedside review: citrate for continuous renal replacement therapy, from science to practice. Crit Care 2012;16:249.
  19. Jacobs R, Honore PM, Spapen HD: Some metabolic issues should not be neglected when using citrate for continuous renal replacement therapy! Crit Care 2015;19:50.
  20. Oudemans-van Straaten HM, Fiaccadori E, Baldwin I: Anticoagulation for renal replacement therapy: different methods to improve safety. Contrib Nephrol 2010;165:251-262.
  21. Ricci D, Panicali L, Facchini MG, Mancini E: Citrate anticoagulation during continuous renal replacement therapy. Contrib Nephrol 2017;190:19-30.
  22. Schetz M: Anticoagulation in continuous renal replacement therapy. Contrib Nephrol 2001;132:283-303.
  23. Jacobs R, Honore PM, Diltoer M, Spapen HD: Chloride content of solutions used for regional citrate anticoagulation might be responsible for blunting correction of metabolic acidosis during continuous veno-venous hemofiltration. BMC Nephrol 2016;17:119.
  24. Vargas Hein O, Kox WJ, Spies C: Anticoagulation in continuous renal replacement therapy. Contrib Nephrol 2004;144:308-316.
  25. Honore PM, Jacobs R, Hendrickx I, De Waele E, Van Gorp V, Spapen HD: Metabolic and coagulation effects of citrate: down to the last detail! Crit Care 2015;19:433.

Article / Publication Details

First-Page Preview
Abstract of  

Published online: March 29, 2018
Cover Date: 2018

Number of Print Pages: 10
Number of Figures: 2
Number of Tables: 0

ISBN: 978-3-318-06306-6 (Print)
eISBN: 978-3-318-06307-3 (Online)

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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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