ObjectiveTo explore the effect of continuous renal replacement therapy (CRRT) to treat sepsis associated acute kidney injury (AKI) in patients aged over 80.MethodsForty-one patients diagnosed with sepsis and AKI were enrolled in geriatric RICU department of Huadong Hospital from January 2013 to July 2018, 38 patients were male and 3 were female. All patients were treated with anti-infection and fluid resuscitation therapy. After comprehensive judgment of the indication of renal replacement, they were divided into two groups by the choices of using CRRT. There were 20 patients in CRRT group and 21 in control group. Clinical data such as age, body mass index, previous diseases, 28-day mortality rate, blood cells, APACHEⅡ as well as SOFA scores were compared between two groups. Blood renal function and inflammatory markers at the first day were also compared to those after 3-day treatment of initial time.ResultsNo statistical difference was observed in sex ratio, age, body mass index and previous diseases between two groups (all P>0.05). There was also no difference in APACHEⅡ score, SOFA score, blood cells, hemoglobin and survival time. The 28-day mortality rate in CRRT group was lower than that in control group (P<0.05). The levels of serum UA and C reactive protein (CRP) in CRRT group decreased after 3-day treatment compared with those at the onset, and the differences were statistically significant (all P<0.05). The level of serum blood urea nitrogen (BUN), creatinine (Cr), uric acid (UA) and cystain C in control group increased after 3 days compared with those at the onset, and the difference were statistically significant (all P<0.05). There was no significant difference in serum BUN, Cr, UA, cystain C, CRP and procalcitonin (PCT) between two groups at the onset (all P>0.05). After 3 days of CRRT, the levels of serum PCT, BUN, Cr and UA in CRRT group were lower than those in the control group (all P<0.05).ConclusionCRRT can improve hyperuricemia, control deterioration of renal function, reduce early systemic inflammatory response and 28-day mortality rate in aged patients with sepsis and AKI.
ObjectiveTo explore the hemodynamic effects of inhaled nitric oxide (iNO) on postoperative hemodynamic in patients with cyanotic congenital heart disease (CHD) combined with decreased pulmonary blood flow.MethodsFrom 2014 to 2018, there were 1 764 patients who received corrective repair of cyanotic CHD with decreased pulmonary blood flow in the Department of Pediatric Cardiac Surgery of Fuwai Hospital. We included 61 patients with the ratio of right ventricular systolic pressure to systolic blood pressure (SBP) ≥75% after weaning from cardiopulmonary bypass. There were 41 males and 20 females, with the age of 20.5 (9.0, 39.0) months and weight of 12.5±7.8 kg. The patients were divided into two groups: a conventional group (33 patients, conventional therapy only) and a combined therapy group (28 patients, iNO combined with conventional therapy). The hemodynamics during the first 24 hours after iNO therapy and the in-hospital outcomes of the two groups were investigated and compared.ResultsThere was no statistical difference between the two groups in demographic characteristics and surgical parameters (P>0.05). The hemodynamic effects of iNO within 24 hours included the decrease in the vasoactive inotropic score (VIS, 21.6±6.6 vs. 17.3±7.2, P=0.020) along with the increase in blood pressure (SBP: 73.7±9.7 mm Hg vs. 90.8±9.1 mm Hg, P<0.001) , the decrease in central venous pressure (10.0±3.1 mm Hg vs. 7.9±2.1 mm Hg, P=0.020), the decrease in lactate (2.2±1.7 mmol/L vs. 1.2±0.5 mmol/L, P<0.001) and increase in urine output [2.8±1.7 mL/(kg·h) vs. 4.9±2.2 mL/(kg·h), P<0.001]. The decrease of VIS at 24 h after the surgery in the conventional therapy group was not statistically significant (22.1±7.9 vs. 20.0±8.5, P=0.232). Besides, we discovered that the need for renal replacement therapy (RRT) was less in the combined therapy group than that in the conventional therapy group, especially in the moderate complicated surgery [risk adjustment in congenital heart surgery (RACHS-1) ≤3] subgroup (9.5% vs. 40.7%, P=0.016).ConclusionIn pediatric patients after corrective repair of cyanotic and pulmonary blood follow decreased CHD with increased pulmonary vascular resistance, iNO combined with conventional therapy can improve the hemodynamics effectively. Compared with the conventional therapy, the combined therapy with iNO can decrease the VIS and the need for RRT, which is beneficial to the postoperative recovery of patients.
Objective To explore the global research status and trends of continuous renal replacement therapy (CRRT) based on knowledge visualization analysis. Methods Based on the Web of Science Core Collection, studies reporting CRRT research that were published between June 2014 and June 2023 were retrieved and collected after manual review. VOSviewer and CiteSpace softwares were used for bibliometric visualization analysis, including publication trends, geographical distribution characteristics, journal distribution characteristics, author contributions, citations, funding source characteristics, and keyword clustering. Results A total of 2708 papers were analyzed, with an increasing trend in the number of articles and citation frequency from 2015 to 2021. The United States was the most prolific country and France was the most influential country. The University of Pittsburgh in the United States had the highest number of publications among research institutions and showed higher motivation for inter-institutional collaboration. The University of Queensland in the Australia had the highest average citation frequency. Professor Rinaldo Bellomo of Australia was the most productive author and Professor Jeffrey Lipman was the most influential. Jason A. Roberts, Jeffrey Lipman and Claudio Ronco were the three authors who had the highest number of collaborations with other authors. Keyword cluster analysis showed that the prognosis of CRRT for renal disease was the focus of research, with hotspots of research being antibiotics, citrate accumulation, plasma replacement, lactate clearance, acute respiratory distress syndrome, and coronavirus disease 2019. Coupling analysis of the literature showed that exploring the indications for CRRT and optimizing treatment prescription were at the forefront of research. Conclusions The present study of CRRT has generally shown an upward trend in the last decade. The management and efficacy of CRRT remains a hot topic of research. Exploring the indications for CRRT and optimizing treatment prescriptions may be a popular research direction and trend in the future.
Objective To investigate and compare the effects of succinylated gelatin injection and saline priming on the first hour blood pressure in critically ill patients receiving continuous renal replacement therapy (CRRT). Methods Inpatients who received continuous venous-venous dialysis filtration therapy in the intensive care unit of West China Hospital of Sichuan University between January and May 2024 were selected. The patients were randomly divided into an experimental group (colloidal solution group) and a control group (crystalloid solution group) in a 1∶1 ratio. The colloidal solution group used succinylated gelatin injection as the priming solution, and used the dual connection method to draw blood to the machine. The patient’s systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rate at 10 minutes before and 0, 1, 3, 5, 10, 30 and 60 minute after CRRT initiation, the name and dosage of vascular compression drugs pumped intravenously at 0, 30 and 60 minutes, and the liquid inlet and outlet in the first hour were monitored and recorded. The crystalloid solution group used normal saline as the priming solution, and the rest of the methods were the same as those of the colloidal solution group. Two groups of patients were compared for changes in blood pressure and heart rate during the first hour of CRRT, as well as the incidence of hypotension. Results A total of 208 patients were included, with 104 cases in each group. There was no significant difference in baseline data between the two groups (P>0.05). At 3 minutes after CRRT, the systolic blood pressure of the crystalloid solution group was lower than that of the colloidal solution group [(122.56±23.82) vs. (129.43±25.46) mm Hg (1 mm Hg=0.133 kPa); t=−2.005, P=0.046]. There was no statistically significant difference in diastolic blood pressure, mean arterial pressure, or heart rate between the two groups at different time points (P>0.05). The intra group comparison results showed that the systolic blood pressure of the crystalloid solution group decreased compared to before at 1, 3, 5, and 10 minutes after CRRT (P<0.05), while the diastolic blood pressure and mean arterial pressure decreased compared to before at 3, 5, and 10 minutes after the start of CRRT (P<0.05); there was no statistically significant difference in blood pressure of the colloidal solution group among different time points after the start of CRRT (P>0.05). The heart rate of the crystalloid solution group was higher at 10 minutes after the start of CRRT than at 3 minutes after CRRT (P=0.045); 60 minutes after the start of CRRT, the heart rate in the colloidal solution group was lower than that 0 minutes after CRRT (P=0.032); there was no statistically significant difference between the two groups at other time points within each group (P>0.05). On the first hour of CRRT, there was a statistically significant difference in the incidence of hypotension between the two groups [33 cases (31.7%) vs. 18 cases (17.3%); χ2=5.845, P=0.016]. Conclusions The use of colloidal solution pre-flushing is more advantageous to improving the decrease in blood pressure in the first hour of CRRT in severe patients than crystalloid solution group pre-flushing. And it can reduce the incidence of hypotension in the first hour of CRRT in severe patients.
In continuous renal replacement therapy (CRRT), the combination of medicine and engineering is propelling advancements in therapeutic technology. By enhancing the biocompatibility and specific adsorption capabilities of the blood adsorption materials, the therapeutic efficacy of CRRT is augmented, leading to a reduction in adverse reactions for patients. Moreover, the application of big data and artificial intelligence in CRRT is continually being developed. Utilizing intelligent devices, data analysis, and machine learning, the initiation, monitoring, and formulation of CRRT treatment plans are optimized, providing clinical patients with more efficient and secure therapeutic options, thereby further improving clinical outcomes.
ObjectiveTo explore the correlation between perioperative blood transfusion and acute kidney injury (AKI) after heart transplantation.MethodsA retrospective study was performed on 67 patients who underwent heart transplantation in the Department of Cardiac Surgery, Guangdong Provincial People's Hospital from January 2016 to December 2018, and finally 63 patients were included according to the exclusion criteria. There were 53 males and 10 females with an average age of 44.3±12.9 years. Twenty patients who adopted continuous renal replacement therapy (CRRT) after heart transplantation were divided into a RT group and the other 43 patients who did not use CRRT were divided into a non-RT group. Baseline characteristics, perioperative blood transfusion data and clinical prognosis were compared between the two groups.ResultsThe preoperative baseline characteristics of the two groups were basically the same. There were significant differences in perioperative infusion of red blood cells and plasma, postoperative 24 h bleeding and re-exploration (P<0.05) between the two groups. The area under the receiver operating characteristic (ROC) curve was 0.923 (95%CI 0.852 to 0.995, P<0.001). The ROC curve showed that perioperative infusion of red blood cells more than 18 mL/kg would increase the incidence of AKI after heart transplantation.ConclusionPerioperative blood transfusion is closely related to AKI after heart transplantation. The more blood transfusion is in clinics, the higher incidence of renal injury is and the worse prognosis is. It is suggested that various blood-saving measures can be carried out.
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.
Objective To evaluate the efficacy and safety of intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT) on patients with acute kidney injury (AKI) after bee sting. Methods A prospective observational analysis was made on patients with AKI after bee sting treated in Jianyang People’s Hospital or West China Hospital of Sichuan University between July 2015 and December 2020. According to different initial renal replacement therapy modes, the patients were divided into IHD group and CRRT group. The IHD group received hemodialysis for 4 hours each time, once a day or 3-5 times a week; the CRRT group used Prismaflex machine for continuous veno-venous hemofiltration or continuous veno-venous hemodiafiltration within 72 hours after admission, for at least 12 hours a day, followed by CRRT or IHD, depending on the patient’s condition. Both groups could be treated with hemoperfusion (HP) and symptomatic support such as glucocorticoid, blood transfusion and fluid rehydration. The IHD group was divided into IHD subgroup and IHD+HP subgroup, and the CRRT group was divided into CRRT subgroup and CRRT+HP subgroup according to whether renal replacement therapy was combined with HP. The basic information of patients and clinical laboratory examination results were collected, and the renal function recovery and mortality rates of patients in the two groups were compared, as well as the changes of laboratory indicators. Results A total of 106 patients were enrolled, 50 in the IHD group and 56 in the CRRT group. There was no statistical difference in the rate of complete renal function recovery 30, 60, or 90 days after treatment between the two groups (28.2% vs. 31.2%, P=0.758; 46.2% vs. 50.0%, P=0.721; 82.1% vs. 81.2%, P=0.924). But in the CRRT subgroup analysis, there was a statistical difference in the 30-day renal function recovery rate of CRRT+HP patients compared with CRRT alone (47.6% vs. 18.5%, P=0.031), while no statistical difference was found in the IHD subgroup analysis. After 3 days of treatment, the levels of creatine kinase of the IHD+HP subgroup and the CRRT+HP subgroup were lower than those in the IHD and CRRT subgroups, and the differences were statistically significant [(7875±6871) vs. (15157±8546) U/L, P=0.026; (10002±8256) vs. (14498±10362) U/L, P=0.032]. There was no statistical difference in 30-day mortality or incidence of serious adverse reactions between the two groups (P>0.05). Conclusions There is no obvious difference in improving renal prognosis or reducing mortality between CRRT and IHD for patients with AKI after bee sting. However, CRRT combined with HP therapy could shorten the recovery time of renal function and increase the 30-day kidney recovery rate. HP may contribute to early renal function recovery in patients with AKI after bee sting, but more high-quality randomized controlled trials are needed to further confirm this.
Acute kidney injury is a worldwide public health issue, and its treatment and management strategies continue to advance. In addition to traditional kidney replacement therapy, research in recent years has been focused on whole organ engineering and biofabrication of kidney assistive devices and bioinjections for in-body regeneration. Hydrogel materials show great potential in renal tissue engineering because of their good biocompatibility, thermal stability and controllable biochemical and mechanical properties. This article reviews the application of various hydrogel materials in renal tissue engineering to promote kidney regeneration and discusses the characteristics and applications of natural hydrogels and synthetic hydrogels, which is expected to further promote their clinical applications.
Objective To evaluate the effects of two filtration fraction formulas on extracorporeal circulation life of continuous renal replacement therapy (CRRT) under regional citrate anticoagulation. Methods Patients with acute kidney injury who received CRRT treatment with regional citrate anticoagulation and the estimated CRRT duration was greater than 24 h at West China Hospital of Sichuan University between June 2022 and April 2023 were selected. They were randomly divided into continuous veno-venous hemofiltration (CVVH), continuous veno-venous hemodialysis (CVVHD) and continuous veno-venous hemodiafiltration (CVVHDF) groups using Prismaflex machines. The life of the CRRT extracorporeal circulation in the three groups of patients was compared, and the reasons for replacing the extracorporeal circulation after 72 h were not used, and the filtration fraction score of the three groups was calculated according to the two filtration score calculation formulas (Formula 1 and Formula 2) currently used in the world. The filtration value obtained by the two filtration fraction calculation formulas was taken as the test variable, and whether the median life of the group with the longest extracorporeal circulation life was taken as the state variable, and the receiver operating characteristic curve was drawn, and the area under the curve was calculated. Results A total of 121 patients were included, including 40 patients in the CVVH group, 40 patients in the CVVHD group, and 41 patients in the CVVHDF group. The extracorporeal circulation life of CVVH group, CVVHD group and CVVHDF group was 64 (46, 71) h, 47 (31.5, 54) h and 70 (65, 72) h, respectively, with statistical difference (log-rank P=0.036). A total of 94 cases were replaced due to filter or venous pot clotting after 72 h after the filter was not used, including 30 cases in the CVVH group, 39 cases in the CVVHD group, and 25 cases in the CVVHDF group. The difference between the three groups was statistically significant (χ2=15.83, P<0.001). According to Formula 1, the filtration fraction of CVVH group, CVVHD group and CVVHDF group was 15.8% (15.2%, 17.0%), 1.1% (0.7%, 2.1%) and 16.2% (14.9%, 17.6%), respectively, and the difference among the three groups was statistically significant (H=69.402, P<0.001). According to Formula 2, the filtration fraction of CVVH group, CVVHD group and CVVHDF group was 33.1% (32.4%, 35.7%), 4.0% (3.6%, 4.9%) and 19.1% (17.7%, 20.7%), respectively, and the differences among the three groups and pairwise comparison between groups were statistically significant (P<0.001). The area under the receiver operating characteristic curvec calculated by the Formula 1 and 2 for the influence of filtration fraction on extracorporeal circulation life were 0.539 and 0.668, the sensitivity were 43.18% and 82.22%, and the specificity were 80.65% and 56.25%, respectively. Conclusions When using Prismaflex machine, the filter life of CVVHD is shorter than CVVH and CVVHDF modes. The filtration fraction calculated by Formula 2 is more sensitive but less specific in predicting CRRT extracorporeal circulation life. Filtration fraction as a CRRT extracorporeal circulation risk assessment has limitations, especially for the CVVH model with pre and post replacement.