{"title":"Outcome studies of continuous renal replacement therapy in the intensive care unit.","authors":"W Silvester","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":17704,"journal":{"name":"Kidney international. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20495039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Electrolyte balances during acute renal failure treated with continuous convective techniques, such as continuous arteriovenous hemofiltration (CAVH) and its pumped variants, are largely dependent on the eloctrolyte plasma concentration available for ultrafiltration, the ultrafiltration rate and the composition of the replacement solution. As blood sodium concentrations measured by potentiometry (Na +P) and the total ultrafiltrate sodium concentration are very similar, Na +P can be taken as the value of ultrafilterable sodium when choosing the correct sodium concentration in the substitution fluid. In CAVH, the ultrafiltrate contains about 3 m Eq/liter of calcium and 1 m Eq/liter of magnesium that must be replaced by the substitution fluid in order to prevent hypocalcemia and hypomagnesemia. In addition, if plasma potassium levels are normal, 3 to 4 mEq/liter of potassium should be added to the replacement fluid to avoid hypokalemia. Although convection and diffusion are combined in continuous hemodialysis, solute transport is largely mediated by convection; however, the net removal of sodium and calcium is significantly influenced by their concentrations in the dialysate, and the risk of hypomagnesemia and hypokalemia can be attenuated by adjusting magnesium and potassium concentrations in the dialysis solution to levels near to the plasma water values. Since critically ill patients are prone to developing dialysis-induced hypophosphatemia, phosphorous must be monitored and supplemented if necessary, Since CRRT works continuously, serious derangement in fluid and electrolyte homeostasis may occur in the absence of careful prescription and extremely vigilant monitoring.
连续对流技术治疗急性肾功能衰竭期间的电解质平衡,如连续动静脉血液滤过(CAVH)及其泵送变体,在很大程度上取决于可用于超滤的电解质血浆浓度、超滤速率和替代溶液的组成。由于电位法测定的血钠浓度(Na +P)与超滤液总钠浓度非常相似,因此在选择正确的替代液钠浓度时,可将Na +P作为超滤钠的值。在CAVH中,超滤液中含有约3 m Eq/l的钙和1 m Eq/l的镁,为了防止低钙血症和低镁血症,必须用替代液代替。此外,如果血浆钾水平正常,应在补液中添加3 - 4meq /l的钾,以避免低钾血症。虽然对流和扩散在连续血液透析中结合,但溶质运输主要由对流介导;然而,钠和钙的净去除受到透析液中其浓度的显著影响,通过调整透析液中的镁和钾浓度至接近血浆水值的水平,可以降低低镁血症和低钾血症的风险。由于危重患者易发生透析所致低磷血症,必须监测并在必要时补充磷。由于CRRT持续作用,如果不仔细处方和高度警惕的监测,可能会发生严重的体液和电解质稳态紊乱。
{"title":"Electrolyte disorders and substitution fluid in continuous renal replacement therapy.","authors":"F Locatelli, G Pontoriero, S Di Filippo","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Electrolyte balances during acute renal failure treated with continuous convective techniques, such as continuous arteriovenous hemofiltration (CAVH) and its pumped variants, are largely dependent on the eloctrolyte plasma concentration available for ultrafiltration, the ultrafiltration rate and the composition of the replacement solution. As blood sodium concentrations measured by potentiometry (Na +P) and the total ultrafiltrate sodium concentration are very similar, Na +P can be taken as the value of ultrafilterable sodium when choosing the correct sodium concentration in the substitution fluid. In CAVH, the ultrafiltrate contains about 3 m Eq/liter of calcium and 1 m Eq/liter of magnesium that must be replaced by the substitution fluid in order to prevent hypocalcemia and hypomagnesemia. In addition, if plasma potassium levels are normal, 3 to 4 mEq/liter of potassium should be added to the replacement fluid to avoid hypokalemia. Although convection and diffusion are combined in continuous hemodialysis, solute transport is largely mediated by convection; however, the net removal of sodium and calcium is significantly influenced by their concentrations in the dialysate, and the risk of hypomagnesemia and hypokalemia can be attenuated by adjusting magnesium and potassium concentrations in the dialysis solution to levels near to the plasma water values. Since critically ill patients are prone to developing dialysis-induced hypophosphatemia, phosphorous must be monitored and supplemented if necessary, Since CRRT works continuously, serious derangement in fluid and electrolyte homeostasis may occur in the absence of careful prescription and extremely vigilant monitoring.</p>","PeriodicalId":17704,"journal":{"name":"Kidney international. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20495041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Drug dosing adjustments during continuous renal replacement therapies.","authors":"T A Golper, M A Marx","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":17704,"journal":{"name":"Kidney international. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20496205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C Tetta, J M Cavaillon, G Camussi, F G Lonnemann, A Brendolan, C Ronco
An in vitro system composed of a plasma separation membrane coupled with natural (charcoal) or synthetic (Amberlite, Amberchrome) types of sorbents was evaluated for the simultaneous removal of proinflammatory cytokines (TNF-alpha, IL-1 beta and IL-8) and cytokine antagonists [interleukin (IL)-1 receptor antagonist (IL-1Ra), soluble tumor necrosis factor-alpha (TNF-alpha) receptor I and II (sTNFR I and II)] in whole blood spiked with bacterial lipopolysaccharide (LPS). These studies showed that plasma filtration rather than ultrafiltration significantly increased the clearance of all cytokines, particularly TNF-alpha, and the synthetic (Amberlite-type of resin) but not natural (uncoated charcoal) membrane could extensively absorb almost 100% of plasma filtered IL-Ra, IL-1 beta and IL-8, but only 40% of TNF-alpha. Other synthetic (Amberchrome) membranes could also effectively (80%) remove TNF-alpha. In the complex scenario of sepsis, the simultaneous removal of excess proinflammatory and/or immunomodulatory mediators may play a role in reducing the hemodynamic alterations, thus resulting in enhanced patient survival. Whether this occurs in the human setting awaits the results of an ongoing clinical investigation.
{"title":"Continuous plasma filtration coupled with sorbents.","authors":"C Tetta, J M Cavaillon, G Camussi, F G Lonnemann, A Brendolan, C Ronco","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>An in vitro system composed of a plasma separation membrane coupled with natural (charcoal) or synthetic (Amberlite, Amberchrome) types of sorbents was evaluated for the simultaneous removal of proinflammatory cytokines (TNF-alpha, IL-1 beta and IL-8) and cytokine antagonists [interleukin (IL)-1 receptor antagonist (IL-1Ra), soluble tumor necrosis factor-alpha (TNF-alpha) receptor I and II (sTNFR I and II)] in whole blood spiked with bacterial lipopolysaccharide (LPS). These studies showed that plasma filtration rather than ultrafiltration significantly increased the clearance of all cytokines, particularly TNF-alpha, and the synthetic (Amberlite-type of resin) but not natural (uncoated charcoal) membrane could extensively absorb almost 100% of plasma filtered IL-Ra, IL-1 beta and IL-8, but only 40% of TNF-alpha. Other synthetic (Amberchrome) membranes could also effectively (80%) remove TNF-alpha. In the complex scenario of sepsis, the simultaneous removal of excess proinflammatory and/or immunomodulatory mediators may play a role in reducing the hemodynamic alterations, thus resulting in enhanced patient survival. Whether this occurs in the human setting awaits the results of an ongoing clinical investigation.</p>","PeriodicalId":17704,"journal":{"name":"Kidney international. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20496210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The use of diuretics in the acute care setting (intensive care units, operating rooms and emergency departments) is an area of significant clinical and laboratory research. These agents are frequently used to facilitate fluid management and in the hopes of protecting the kidneys from injury. The pros and cons of continuous infusion of loop diuretics, and albumin supplementation are discussed along with the issues related to their use to avoid dialysis or to improve outcome. In addition, the evidences is support of the use diuretics to prevent or treat acute failure in the acute care setting are reviewed and discussed.
{"title":"Use of diuretics in the acute care setting.","authors":"J A Kellum","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The use of diuretics in the acute care setting (intensive care units, operating rooms and emergency departments) is an area of significant clinical and laboratory research. These agents are frequently used to facilitate fluid management and in the hopes of protecting the kidneys from injury. The pros and cons of continuous infusion of loop diuretics, and albumin supplementation are discussed along with the issues related to their use to avoid dialysis or to improve outcome. In addition, the evidences is support of the use diuretics to prevent or treat acute failure in the acute care setting are reviewed and discussed.</p>","PeriodicalId":17704,"journal":{"name":"Kidney international. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20493853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Continuous versus intermittent renal replacement therapy in the intensive care unit.","authors":"R Bellomo, C Ronco","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":17704,"journal":{"name":"Kidney international. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20495036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Based on numerous studies demonstrating a direct relationship between survival and delivered hemodialysis (HD) dose in end-stage renal disease (ESRD), quantification of delivered HD is now routinely performed in this setting. Recently, investigators have also begun applying kinetic modeling principles to quantify delivered dialysis dose in patients with acute renal failure (ARF). One purpose of this article is to review these ARF studies. However, a broader objective is to provide an overview of the solute removal capabilities of both intermittent and continuous therapies used in ARF. To achieve this goal, the dialytic removal mechanisms for solutes over a wide molecular weight spectrum are discussed.
{"title":"Renal replacement therapy in acute renal failure: solute removal mechanisms and dose quantification.","authors":"W R Clark, C Ronco","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Based on numerous studies demonstrating a direct relationship between survival and delivered hemodialysis (HD) dose in end-stage renal disease (ESRD), quantification of delivered HD is now routinely performed in this setting. Recently, investigators have also begun applying kinetic modeling principles to quantify delivered dialysis dose in patients with acute renal failure (ARF). One purpose of this article is to review these ARF studies. However, a broader objective is to provide an overview of the solute removal capabilities of both intermittent and continuous therapies used in ARF. To achieve this goal, the dialytic removal mechanisms for solutes over a wide molecular weight spectrum are discussed.</p>","PeriodicalId":17704,"journal":{"name":"Kidney international. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20495038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}