Continuous renal replacement therapy for special types of acidosis_West China Medical Journal

Authors：

LI Peiyun , WEI Tiantian ,  ZHANG Ling

Department of Nephrology / Kidney Research Institute,West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

ZHANG Ling, Email: zhanglinglzy@163.com

Keywords：

Continuous renal replacement therapy; Lactic acidosis; Citrate acidosis; Dabetic ketoacidosis; Hypercapnic acidosis

DOI：

10.7507/1002-0179.201806125

Video：

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Continuous renal replacement therapy (CRRT) is a term of blood purification technique that can continuously remove the body's solute and water for 24 hours without any interruption throughout each day. It has several advantages such as hemodynamic stability, accurate capacity control, stable internal environment, and inflammatory regulation, which is especially suitable for patients with severe hemodynamic instability. In clinical practice, critically ill patients treated with CRRT are often associated with different types of acidosis, including metabolic acidosis, lactic acidosis, citrate acidosis, ketoacidosis and hypercapnic acidosis. Different types of acidosis can be treated in different ways. This paper reviews the CRRT for special types of acidosis.

Citation： LI Peiyun, WEI Tiantian, ZHANG Ling. Continuous renal replacement therapy for special types of acidosis. West China Medical Journal, 2018, 33(7): 896-899. doi: 10.7507/1002-0179.201806125 Copy

1.	Rabindranath K, Adams J, Macleod AM, et al. Intermittent versus continuous renal replacement therapy for acute renal failure in adults. Cochrane Database Syst Rev, 2007, 18(3): CD003773.
2.	Kraut JA, Madias NE. Treatment of acute metabolic acidosis: a pathophysiologic approach. Nat Rev Nephrol, 2012, 8(10): 589-601.
3.	Bellomo R, Lipcsey M, Calzavacca P, et al. Early acid-base and blood pressure effects of continuous renal replacement therapy intensity in patients with metabolic acidosis. Intensive Care Med, 2013, 39(3): 429-436.
4.	Boyd JH, Walley KR. Is there a role for Sodium bicarbonate in treating lactic acidosis from shock?. Curr Opin Crit Care, 2008, 14(4): 379-383.
5.	Casserly B, Phillips GS, Schorr C, et al. Lactate measurements in sepsis-induced tissue hypoperfusion: results from the surviving sepsis campaign database. Crit Care Med, 2015, 43(3): 567-573.
6.	Jung B, Rimmele T, Goff CL, et al. Severe metabolic or mixed acidemia on intensive care unit admission: incidence, prognosis and administration of buffer therapy. A prospective, multiple-center study. Crit Care, 2011, 15(5): R238-R238.
7.	Severs D, Hoorn EJ, Rookmaaker MB. A critical appraisal of intravenous fluids: from the physiological basis to clinical evidence. Nephrol Dial Transplant, 2015, 30(2): 178-187.
8.	Kraut JA, Kurtz I. Use of base in the treatment of severe acidemic states. Am J Kidney Dis, 2001, 38(4): 703-727.
9.	Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA, 2016, 315: 801.
10.	Cheungpasitporn W, Zand L, Dillon JJ, et al. Lactate clearance and metabolic aspects of continuous high-volume hemofiltration. Clin Kidney J, 2015, 8(4): 374-377.
11.	Tolwani AJ, Campbell RC, Schenk MB, et al. Simplified citrate anticoagulation for continuous renal replacement therapy. Kidney Int, 2001, 60(1): 370-374.
12.	Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guidelinefor acute kidney injury. Kidney Int Suppl, 2012, 2(1): 1-138.
13.	Morita Y, Hall DS, Johnson RW, et al. Regional anticoagulation during hemodialysis using citrate. Am J Med Sci, 1961, 242(1): 32.
14.	Apsner R, Schwarzenhofer M, Derfler K, et al. Impairment of citrate metabolism in acute hepatic failure. Wien Klin Wochenschr, 1997, 109(4): 123-127.
15.	Kramer L, Bauer E, Joukhadar C, et al. Citrate pharmacokinetics and metabolism in cirrhotic and noncirrhotic critically ill patients. Crit Care Med, 2003, 31(10): 2450-2455.
16.	Cerdá J, Tolwani AJ, Warnock DG. Critical care nephrology: management of acid-base disorders with CRRT. Kidney Int, 2012, 82(1): 9-18.
17.	Foster DW, Mcgarry JD. The metabolic derangements and treatment of diabetic ketoacidosis. N Engl J Med, 1983, 309(3): 159-169.
18.	岳荣铮, 张凌. 连续性血液净化治疗糖尿病肾病酮症酸中毒合并急性肾损伤临床分析. 四川大学学报: 医学版, 2012, 43(3): 434-437.
19.	Kawata H, Inui D, Ohto J, et al. The use of continuous hemodiafiltration in a patient with diabetic ketoacidosis. J Anesth, 2006, 20(2): 129-131.
20.	Holanda Peña MS, Suberviola Cañas B, González Castro A, et al. Severe lactic acidosis associated to metformin intoxication. Nutr Hosp. 2007, 22(1): 124-125.
21.	Liu KD, Glidden DV, Eisner MD, et al. Predictive and pathogenetic value of plasma biomarkers for acute kidney injury in patients with acute lung injury. Crit Care Med, 2007, 35(12): 2755-2761.
22.	Soto GJ, Frank AJ, Christiani DC, et al. Body mass index and acute kidney injury in the acute respiratory distress syndrome. Crit Care Med, 2012, 40(9): 2601-2608.
23.	Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med, 2000, 342(18): 1301-1308.
24.	Livigni S, Maio M, Ferretti E, et al. Efficacy and safety of a low-flow veno-venous carbon dioxide removal device: results of an experimental study in adult sheep. Crit Care, 2006, 10(5): R151.
25.	Christian F, Jens S, Stefan J, et al. Low-flow CO₂ removal integrated into a renal-replacement circuit can reduce acidosis and decrease vasopressor requirements. Crit Care, 2013, 17(4): R154.
26.	Allardet-Servent J, Castanier M, Signouret T, et al. Safety and efficacy of combined extracorporeal CO₂ removal and renal replacement therapy in patients with acute respiratory distress syndrome and acute kidney injury: the pulmonary and renal support in acute respiratory distress syndrome study. Crit Care Med, 2015, 43(12): 2570-2581.
27.	Romagnoli S, Ricci Z, Ronco C. Novel extracorporeal therapies for combined renal-pulmonary dysfunction. Semin Nephrol, 2016, 36(1): 71-77.

1. Rabindranath K, Adams J, Macleod AM, et al. Intermittent versus continuous renal replacement therapy for acute renal failure in adults. Cochrane Database Syst Rev, 2007, 18(3): CD003773.
2. Kraut JA, Madias NE. Treatment of acute metabolic acidosis: a pathophysiologic approach. Nat Rev Nephrol, 2012, 8(10): 589-601.
3. Bellomo R, Lipcsey M, Calzavacca P, et al. Early acid-base and blood pressure effects of continuous renal replacement therapy intensity in patients with metabolic acidosis. Intensive Care Med, 2013, 39(3): 429-436.
4. Boyd JH, Walley KR. Is there a role for Sodium bicarbonate in treating lactic acidosis from shock?. Curr Opin Crit Care, 2008, 14(4): 379-383.
5. Casserly B, Phillips GS, Schorr C, et al. Lactate measurements in sepsis-induced tissue hypoperfusion: results from the surviving sepsis campaign database. Crit Care Med, 2015, 43(3): 567-573.
6. Jung B, Rimmele T, Goff CL, et al. Severe metabolic or mixed acidemia on intensive care unit admission: incidence, prognosis and administration of buffer therapy. A prospective, multiple-center study. Crit Care, 2011, 15(5): R238-R238.
7. Severs D, Hoorn EJ, Rookmaaker MB. A critical appraisal of intravenous fluids: from the physiological basis to clinical evidence. Nephrol Dial Transplant, 2015, 30(2): 178-187.
8. Kraut JA, Kurtz I. Use of base in the treatment of severe acidemic states. Am J Kidney Dis, 2001, 38(4): 703-727.
9. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA, 2016, 315: 801.
10. Cheungpasitporn W, Zand L, Dillon JJ, et al. Lactate clearance and metabolic aspects of continuous high-volume hemofiltration. Clin Kidney J, 2015, 8(4): 374-377.
11. Tolwani AJ, Campbell RC, Schenk MB, et al. Simplified citrate anticoagulation for continuous renal replacement therapy. Kidney Int, 2001, 60(1): 370-374.
12. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guidelinefor acute kidney injury. Kidney Int Suppl, 2012, 2(1): 1-138.
13. Morita Y, Hall DS, Johnson RW, et al. Regional anticoagulation during hemodialysis using citrate. Am J Med Sci, 1961, 242(1): 32.
14. Apsner R, Schwarzenhofer M, Derfler K, et al. Impairment of citrate metabolism in acute hepatic failure. Wien Klin Wochenschr, 1997, 109(4): 123-127.
15. Kramer L, Bauer E, Joukhadar C, et al. Citrate pharmacokinetics and metabolism in cirrhotic and noncirrhotic critically ill patients. Crit Care Med, 2003, 31(10): 2450-2455.
16. Cerdá J, Tolwani AJ, Warnock DG. Critical care nephrology: management of acid-base disorders with CRRT. Kidney Int, 2012, 82(1): 9-18.
17. Foster DW, Mcgarry JD. The metabolic derangements and treatment of diabetic ketoacidosis. N Engl J Med, 1983, 309(3): 159-169.
18. 岳荣铮, 张凌. 连续性血液净化治疗糖尿病肾病酮症酸中毒合并急性肾损伤临床分析. 四川大学学报: 医学版, 2012, 43(3): 434-437.
19. Kawata H, Inui D, Ohto J, et al. The use of continuous hemodiafiltration in a patient with diabetic ketoacidosis. J Anesth, 2006, 20(2): 129-131.
20. Holanda Peña MS, Suberviola Cañas B, González Castro A, et al. Severe lactic acidosis associated to metformin intoxication. Nutr Hosp. 2007, 22(1): 124-125.
21. Liu KD, Glidden DV, Eisner MD, et al. Predictive and pathogenetic value of plasma biomarkers for acute kidney injury in patients with acute lung injury. Crit Care Med, 2007, 35(12): 2755-2761.
22. Soto GJ, Frank AJ, Christiani DC, et al. Body mass index and acute kidney injury in the acute respiratory distress syndrome. Crit Care Med, 2012, 40(9): 2601-2608.
23. Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med, 2000, 342(18): 1301-1308.
24. Livigni S, Maio M, Ferretti E, et al. Efficacy and safety of a low-flow veno-venous carbon dioxide removal device: results of an experimental study in adult sheep. Crit Care, 2006, 10(5): R151.
25. Christian F, Jens S, Stefan J, et al. Low-flow CO₂ removal integrated into a renal-replacement circuit can reduce acidosis and decrease vasopressor requirements. Crit Care, 2013, 17(4): R154.
26. Allardet-Servent J, Castanier M, Signouret T, et al. Safety and efficacy of combined extracorporeal CO₂ removal and renal replacement therapy in patients with acute respiratory distress syndrome and acute kidney injury: the pulmonary and renal support in acute respiratory distress syndrome study. Crit Care Med, 2015, 43(12): 2570-2581.
27. Romagnoli S, Ricci Z, Ronco C. Novel extracorporeal therapies for combined renal-pulmonary dysfunction. Semin Nephrol, 2016, 36(1): 71-77.

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