2017 Taiwan continuous renal replacement therapy operational manual for critically ill patients_West China Medical Journal

Authors：

CHUANG Chiaolin ^1,2 ,  HUNG Fangming ³ , CHAN Mingcheng ⁴ , KU Shihchi ⁵ , HSU Hsianghao ⁶

1. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 11217, China;
2. Faculty of Medicine, Yang-Ming University School of Medicine, Taipei, Taiwan 11221, China;
3. SICU, Far Eastern Memorial Hospital, New Taipei, Taiwan 220, China;
4. Division of Respiratory Therapy, Taichung Veterans General Hospital, Taichung, Taiwan 40705, China;
5. Division of Pulmonary Medicine, Taiwan University Hospital, Taipei, Taiwan 10002, China;
6. Division of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan 333, China;

Corresponding author：

HUNG Fangming, Email: drphilip101@gmail.com

Keywords：

Acute kidney injury; Continuous renal replacement therapy; Critically ill; Operational manual

DOI：

10.7507/1002-0179.201807062

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Acute kidney injury is a common complication and is associated with multiple organ dysfunction syndrome among critically ill patients in intensive care unit. Once renal replacement therapy in required, the mortality rate was high. Using slow and uninterrupted clearance of retained fluid and toxins, continuous renal replacement therapy (CRRT) can avoid hemodynamic instability while provide acid-base, electrolytes, and volume homeostasis. For decades, CRRT has become the dominant form of renal replacement therapy as well as multiple organ support in critically ill patient with acute kidney injury. However, there remains wide practice variation in the CRRT care when clinicians take into account the needs of individual patients, available resources, and limitations unique to an institution or type of practice, despite evidences to guide practice. In addition, CRRT is a complex technology that is resource-intensive, costly, and requires specialized training by health providers.Taiwan Society of Critical Care Medicine organized a group of experts in critical care and nephrology to review the recommendations and provide their clinical practice and concerns to write this operational manual. The purpose of this manual is to provide step-by-step instructions on the practice of CRRT and troubleshooting. In addition, it is designed to help the newbies to carry out this complex treatment correctly and efficiently. We hope that this operational manual is of value to improve clinical skills, quality of care, and patient safety.

Citation： CHUANG Chiaolin, HUNG Fangming, CHAN Mingcheng, KU Shihchi, HSU Hsianghao. 2017 Taiwan continuous renal replacement therapy operational manual for critically ill patients. West China Medical Journal, 2018, 33(7): 816-823. doi: 10.7507/1002-0179.201807062 Copy

1.	Hoste EA, Bagshaw SM, Bellomo R, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med, 2015, 41(8): 1411-1423.
2.	Wald R, Mcarthur E, Adhikari NK, et al. Changing incidence and outcomes following dialysis-requiring acute kidney injury among critically ill adults: a population-based cohort study. Am J Kidney Dis, 2015, 65(6): 870-877.
3.	Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl, 2012, 2（1）: 1-138.
4.	Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med, 2017, 45(3): 486-552.
5.	Tolwani A. Continuous renal-replacement therapy for acute kidney injury. N Engl J Med, 2012, 367 (26): 2505-2514.
6.	Bagshaw SM, Wald R. Strategies for the optimal timing to start renal replacement therapy in critically ill patients with acute kidney injury. Kidney Int, 2017, 91(5): 1022-1032.
7.	Ostermann M, Joannidis M, Pani A, et al. Patient selection and timing of continuous renal replacement therapy. Blood Purif, 2016, 42(3): 224-237.
8.	Claure-Del Gramdo R, Macedo E, Chertow GM, et al. Effluent volume in continuous renal replacement therapy overestimates the delivered dose of dialysis. Clin J Am Soc Nephrol, 2011, 6(3): 467-475.
9.	Merrer J, De Jonghe B, Golliot F, et al. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA, 2001, 286(6): 700-707.
10.	Oliver MJ. Acute dialysis catheters. Semin Dial, 2001, 14(6): 432-435.
11.	Joannidis M, Oudemans-van Straaten HM. Clinical review: patency of the circuit in continuous renal replacement therapy. Crit Care, 2007, 11(4): 218.
12.	Uchino S, Bellomo R, Morimatsu H, et al. Discontinuation of continuous renal replacement therapy: a post hoc analysis of a prospective multicenter observational study. Crit Care Med, 2009, 37(9): 2576-2582.
13.	Wu VC, Ko WJ, Chang HW, et al. Risk factors of early redialysis after weaning from postoperative acute renal replacement therapy. Intensive Care Med, 2008, 34(1): 101-108.
14.	Bagshaw SM, Chakravarthi MR, Ricci Z, et al. Precision continuous renal replacement therapy and solute control. Blood Purif, 2016, 42(3): 238-247.

1. Hoste EA, Bagshaw SM, Bellomo R, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med, 2015, 41(8): 1411-1423.
2. Wald R, Mcarthur E, Adhikari NK, et al. Changing incidence and outcomes following dialysis-requiring acute kidney injury among critically ill adults: a population-based cohort study. Am J Kidney Dis, 2015, 65(6): 870-877.
3. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl, 2012, 2（1）: 1-138.
4. Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med, 2017, 45(3): 486-552.
5. Tolwani A. Continuous renal-replacement therapy for acute kidney injury. N Engl J Med, 2012, 367 (26): 2505-2514.
6. Bagshaw SM, Wald R. Strategies for the optimal timing to start renal replacement therapy in critically ill patients with acute kidney injury. Kidney Int, 2017, 91(5): 1022-1032.
7. Ostermann M, Joannidis M, Pani A, et al. Patient selection and timing of continuous renal replacement therapy. Blood Purif, 2016, 42(3): 224-237.
8. Claure-Del Gramdo R, Macedo E, Chertow GM, et al. Effluent volume in continuous renal replacement therapy overestimates the delivered dose of dialysis. Clin J Am Soc Nephrol, 2011, 6(3): 467-475.
9. Merrer J, De Jonghe B, Golliot F, et al. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA, 2001, 286(6): 700-707.
10. Oliver MJ. Acute dialysis catheters. Semin Dial, 2001, 14(6): 432-435.
11. Joannidis M, Oudemans-van Straaten HM. Clinical review: patency of the circuit in continuous renal replacement therapy. Crit Care, 2007, 11(4): 218.
12. Uchino S, Bellomo R, Morimatsu H, et al. Discontinuation of continuous renal replacement therapy: a post hoc analysis of a prospective multicenter observational study. Crit Care Med, 2009, 37(9): 2576-2582.
13. Wu VC, Ko WJ, Chang HW, et al. Risk factors of early redialysis after weaning from postoperative acute renal replacement therapy. Intensive Care Med, 2008, 34(1): 101-108.
14. Bagshaw SM, Chakravarthi MR, Ricci Z, et al. Precision continuous renal replacement therapy and solute control. Blood Purif, 2016, 42(3): 238-247.

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