Scientia et Cura: Illuminating the Dark Side of CRRT for Optimal Patient Benefits
DOI:
https://doi.org/10.61882/ijkd.19.1.50Keywords:
CRRT, Acute Kidney Injury, Anemia, Platelets, Mean Arterial Pressure, Vasopressor, Electrolytes, Blood PressureAbstract
Introduction. Continuous Renal Replacement Therapy (CRRT) is commonly used in patients with hemodynamic instability but is associated with potential complications. Understanding these complications can improve CRRT efficiency and patient outcomes. Methods. This cross-sectional study investigated CRRT complications in patients > 18 years old who underwent CRRT at a tertiary medical center from 2017 to 2022. Data were collected from patient records and the hospital’s laboratory system.
Results. A total of 178 patients underwent CRRT for fluid overload (38%) and non-septic acute kidney injury (AKI) (35%). The most common CRRT modalities were hemofiltration (54%) and hemodiafiltration (31%). Among patients, 76% experienced a reduction in platelet count (mean decrease of 40% ± 24). Hemoglobin declined by ≥ 1 g/dL in 58% of patients. Phosphorus decreased in 64.6% of patients (mean reduction of 33%) and potassium decreased in 50% (mean reduction of 18%), but these reductions were not statistically significant (P-values: 0.73 and 0.88). Vasopressors were stopped in 27% of patients, and the dose was reduced in 50.4%. No significant hypothermia, allergic reactions, pneumothorax, hemothorax, or air embolism were reported. The survival rate at hospital discharge was 64% (123 out of 178).
Conclusion. CRRT is a safe and efficient treatment for AKI, with notable reductions in platelet count and vasopressor dependency. However, reductions in phosphorus and potassium were not significant, indicating manageable complications.
Downloads
References
1. Tandukar S, Palevsky PM. Continuous renal replacement therapy: who, when, why, and how. Chest. 2019;155(3):626-38.
2. Macedo E, Mehta RL. Continuous dialysis therapies: core curriculum 2016. Am J Kidney Dis. 2016;68(4):645-57.
3. Connor Jr M, Tolwani A. Prescription of continuous renal replacement therapy in acute kidney injury in adults. UpToDate. 2018.
4. Hall NA, Fox AJ. Renal replacement therapies in critical care. Continuing Education in Anaesthesia, Critical Care & Pain. 2006;6(5):197-202.
5. Ostermann M, et al. Nomenclature of extracorporeal blood purification therapies for acute indications: The Nomenclature Standardization Conference. Blood Purif. 2023;1. doi: 10.1159/000533468.
6. Baker A, Anaesthetic S, Green R. Renal replacement therapy in critical care tutorial of the week 194 30th August 2010.
7. Gautam SC, Lim J, Jaar BG. Complications associated with continuous RRT. Kidney360. 2022;3(11):1980-1990. doi: 10.34067/KID.0000792022.
8. Akhoundi A, Singh B, Vela M, Chaudhary S, Monaghan M, Wilson GA, et al. Incidence of adverse events during continuous renal replacement therapy. Blood Purif. 2015;39(4):333-9.
9. Al-Dorzi HM, Alhumaid NA, Alwelyee NH, Albakheet NM, Nazer RI, Aldakhil SK, et al. Anemia, blood transfusion, and filter life span in critically ill patients requiring continuous renal replacement therapy for acute kidney injury: A case-control study. Crit Care Res Pract. 2019;2019.
10. Wester JP, Haas FJ, Biesma DH, Leusink J, Veth G. Thrombosis and hemorrhage in heparin-induced thrombocytopenia in seriously ill patients. Intensive Care Med. 2004;30:1927-34.
11. Graham AS, Ozment C, Tegtmeyer K, Lai S, Braner DA. Central venous catheterization. N Engl J Med. 2007;356(21):e21.
12. Ferreira JA, Johnson DW. The incidence of thrombocytopenia associated with continuous renal replacement therapy in critically ill patients. Ren Fail. 2015;37(7):1232-6.
13. Vanderschueren S, De Weerdt A, Malbrain M, Vankersschaever D, Frans E, Wilmer A, et al. Thrombocytopenia and prognosis in intensive care. Crit Care Med. 2000;28(6):1871-6.
14. Griffin BR, Jovanovich A, You Z, Palevsky P, Faubel S, Jalal D. Effects of baseline thrombocytopenia and platelet decrease following RRT initiation in patients with severe AKI. Crit Care Med. 2019;47(4):e325.
15. Pschowski R, Briegel S, Von Haehling S, Doehner W, Bender T, Pape U, et al. Effects of dialysis modality on blood loss, bleeding complications and transfusion requirements in critically ill patients with dialysis-dependent acute renal failure. Anaesth Intensive Care. 2015;43(6):764-70.
16. Ebo D, Bosmans J, Couttenye M, Stevens W. Haemodialysis-associated anaphylactic and anaphylactoid reactions. Allergy. 2006;61(2):211-20.
17. Santiago MJ, López-Herce J, Urbano J, Solana MJ, del Castillo J, Ballestero Y, et al. Complications of continuous renal replacement therapy in critically ill children: a prospective observational evaluation study. Critical Care. 2009;13:1-11.
18. Network VNARFT. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008;359(1):7-20.
19. Investigators RRTS. Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med. 2009;361(3):1627-38.
20. Hendrix RJ, Hastings MC, Samarin M, Hudson JQ. Predictors of hypophosphatemia and outcomes during continuous renal replacement therapy. Blood Purif. 2020;49(6):700-7.
21. Broman M, Carlsson O, Friberg H, Wieslander A, Godaly G. Phosphate-containing dialysis solution prevents hypophosphatemia during continuous renal replacement therapy. Acta Anaesthesiol Scand. 2011;55(1):39-45.
22. Di Mario F, Regolisti G, Greco P, Maccari C, Superchi E, Morabito S, et al. Prevention of hypomagnesemia in critically ill patients with acute kidney injury on continuous kidney replacement therapy: the role of early supplementation and close monitoring. Journal of Nephrology. 2021;34:1271-9.
23. Guru PK, et al. Association of thrombocytopenia and mortality in critically ill patients on continuous renal replacement therapy. Nephron Journals. 2016;133(3):175-82. doi: 10.1159/000447543.
24. Griffin BR, et al. The association of platelet decrease following continuous renal replacement therapy initiation and increased rates of secondary infections. Crit Care Med. 2020;49(2):e130-e139. doi: 10.1097/ccm.0000000000004763.
25. Gautam SC, Lim J, Jaar BG. Complications associated with continuous RRT. Kidney360. 2022;3(11):1980-1990. doi: 10.34067/KID.0000792022.
26. Santiago MJ, López-Herce J, Urbano J, Solana MJ, del Castillo J, Ballestero Y, et al. Complications of continuous renal replacement therapy in critically ill children: a prospective observational evaluation study. Critical Care. 2009;13:1-11.
Downloads
Published
Data Availability Statement
data availability
