Precision continuous renal replacement therapy: anticoagulation, dosage and volume management_West China Medical Journal

Authors：

SONG Guojiao ^1,2 , ZHOU Lu ¹ , ZHANG Ling ¹ ,  ZHAO Yuliang ¹

1. Department of Nephrology and Institute of Kidney Disease, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

ZHAO Yuliang, Email: zhaoyuliang@scu.edu.cn

Keywords：

Continuous renal replacement therapy; anticoagulation; dosage; volume management; precise prescription

DOI：

10.7507/1002-0179.202406152

Video：

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Continuous renal replacement therapy (CRRT) is an important therapy for patients with severe acute kidney injury. With the development of blood purification, the application of CRRT has been beyond the scope of kidney disease and developed into a comprehensive and integrated organ support platform, providing a hybrid treatment of different blood purification techniques. With the advancement of informatization, it is possible to improve the quality of CRRT treatment to formulate individualized and precise treatment based on the specific information of patients. This article will discuss the precise prescription and development prospective of CRRT from three dimensions: anticoagulation, dosage and volume management.

Citation： SONG Guojiao, ZHOU Lu, ZHANG Ling, ZHAO Yuliang. Precision continuous renal replacement therapy: anticoagulation, dosage and volume management. West China Medical Journal, 2024, 39(7): 1126-1130. doi: 10.7507/1002-0179.202406152 Copy

1.	Oudemans-van Straaten, HM. Hemostasis and thrombosis in continuous renal replacement treatment. Semin Thromb Hemost, 2015, 41(1): 91-98.
2.	Joannidis M, Oudemans-van Straaten HM. Clinical review: patency of the circuit in continuous renal replacement therapy. Crit Care, 2007, 11(4): 218.
3.	Zhou Z, Liu C, Yang Y, et al. Anticoagulation options for continuous renal replacement therapy in critically ill patients: a systematic review and network meta-analysis of randomized controlled trials. Crit Care, 2023, 27(1): 222.
4.	Legrand M, Tolwani A. Anticoagulation strategies in continuous renal replacement therapy. Semin Dial, 2021, 34(6): 416-422.
5.	普亚军, 张凌, 王芳, 等. 局部枸橼酸抗凝在血液灌流联合连续性肾脏替代治疗中的应用观察. 华西医学, 2023, 38(8): 1174-1180.
6.	骆强, 卿山林, 田中, 等. 局部枸橼酸抗凝与低分子肝素抗凝对行 CRRT 治疗脓毒症患者疗效及对凝血功能的影响. 解放军医药杂志, 2020, 32(2): 56-59.
7.	Liu SY, Xu SY, Yin L, et al. Management of regional citrate anticoagulation for continuous renal replacement therapy: guideline recommendations from Chinese emergency medical doctor consensus. Mil Med Res, 2023, 10(1): 23.
8.	孙菲菲, 吉挺. 低分子肝素抗凝在连续肾脏替代治疗中的应用效果. 护理研究, 2022, 36(17): 3116-3120.
9.	Clyde M, Brianne W, Kathryn D. 1327: evaluation of low- versus high-dose heparin protocols for continuous renal replacement therapy. Crit Care Med, 2024, 52(1): S635.
10.	Hu ZJ, Iwama H, Suzuki R, et al. Time course of activated coagulation time at various sites during continuous haemodiafiltration using nafamostat mesilate. Intensive Care Med, 1999, 25(5): 524-527.
11.	Baek NN, Jang HR, Huh W, et al. The role of nafamostat mesylate in continuous renal replacement therapy among patients at high risk of bleeding. Ren Fail, 2012, 34(3): 279-285.
12.	Abe H, Tani T, Numa K, et al. Efficacy of nafamostat mesilate as a regional anticoagulant in experimental direct hemoperfusion and in plasma exchange on humans. Artif Organs, 1992, 16(2): 206-208.
13.	Kamijo H, Mochizuki K, Nakamura Y, et al. Nafamostat mesylate improved survival outcomes of sepsis patients who underwent blood purification: a nationwide registry study in Japan. J Clin Med, 2020, 9(8): 2629.
14.	北村伸哉, 张凌. 甲磺酸萘莫司他在连续性肾脏替代治疗中的抗凝应用. 华西医学, 2018, 33(7): 801-805.
15.	黄美春, 庄耀宁, 陈敏敏, 等. 无肝素连续性肾脏替代治疗血液透析导管堵塞临床征象及相关因素分析. 全科护理, 2021, 19(22): 3089-3094.
16.	张丽涓, 张毅, 王玺, 等. 连续性肾脏替代疗法患者使用无肝素、普通肝素与枸橼酸钠抗凝时血小板的变化情况. 四川医学, 2013, 34(3): 326-328.
17.	Dunn WJ, Sriram S. Filter lifespan in critically ill adults receiving continuous renal replacement therapy: the effect of patient and treatment-related variables. Crit Care Resusc, 2014, 16(3): 225-231.
18.	Sansom B, Sriram S, Presneill J, et al. Low blood flow continuous veno-venous haemodialysis compared with higher blood flow continuous veno-venous haemodiafiltration: effect on alarm rates, filter life, and azotaemic control. Blood Purif, 2022, 51(2): 130-137.
19.	Ronco C, Bellomo R, Homel P, et al. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet, 2000, 356(9223): 26-30.
20.	Prowle JR, Schneider A, Bellomo R. Clinical review: optimal dose of continuous renal replacement therapy in acute kidney injury. Crit Care, 2011, 15(2): 207.
21.	Yin F, Zhang F, Liu S, et al. The therapeutic effect of high-volume hemofiltration on sepsis: a systematic review and meta-analysis. Ann Transl Med, 2020, 8(7): 488.
22.	Atan R, Peck L, Prowle J, et al. A double-blind randomized controlled trial of high cutoff versus standard hemofiltration in critically ill patients with acute kidney injury. Crit Care Med, 2018, 46(10): e988-e994.
23.	Murugan R, Hoste E, Mehta RL, et al. Precision fluid management in continuous renal replacement therapy. Blood Purif, 2016, 42(3): 266-278.
24.	Woodward CW, Lambert J, Ortiz-Soriano V, et al. Fluid overload associates with major adverse kidney events in critically ill patients with acute kidney injury requiring continuous renal replacement therapy. Crit Care Med, 2019, 47(9): e753-e760.
25.	Hall A, Crichton S, Dixon A, et al. Fluid removal associates with better outcomes in critically ill patients receiving continuous renal replacement therapy: a cohort study. Crit Care, 2020, 24(1): 279.
26.	Ronco C, Kaushik M, Valle R, et al. Diagnosis and management of fluid overload in heart failure and cardio-renal syndrome: the “5B” approach. Semin Nephrol, 2012, 32(1): 129-141.
27.	Heise D, Faulstich M, Mörer O, et al. Influence of continuous renal replacement therapy on cardiac output measurement using thermodilution techniques. Minerva Anestesiol, 2012, 78(3): 315-321.
28.	Murugan R, Ostermann M, Peng Z, et al. Net ultrafiltration prescription and practice among critically ill patients receiving renal replacement therapy: a multinational survey of critical care practitioners. Crit Care Med, 2020, 48(2): e87-e97.
29.	Sansom B, Udy A, Presneill J, et al. Early net ultrafiltration during continuous renal replacement therapy: impact of admission diagnosis and association with mortality. Blood Purif, 2024, 53(3): 170-180.
30.	张莎莎, 韩代成, 刘冲冲, 等. 脓毒症休克伴急性肾损伤新生儿抗菌药物剂量调整的个体化治疗实践. 中国药师, 2022, 25(7): 1213-1217.

1. Oudemans-van Straaten, HM. Hemostasis and thrombosis in continuous renal replacement treatment. Semin Thromb Hemost, 2015, 41(1): 91-98.
2. Joannidis M, Oudemans-van Straaten HM. Clinical review: patency of the circuit in continuous renal replacement therapy. Crit Care, 2007, 11(4): 218.
3. Zhou Z, Liu C, Yang Y, et al. Anticoagulation options for continuous renal replacement therapy in critically ill patients: a systematic review and network meta-analysis of randomized controlled trials. Crit Care, 2023, 27(1): 222.
4. Legrand M, Tolwani A. Anticoagulation strategies in continuous renal replacement therapy. Semin Dial, 2021, 34(6): 416-422.
5. 普亚军, 张凌, 王芳, 等. 局部枸橼酸抗凝在血液灌流联合连续性肾脏替代治疗中的应用观察. 华西医学, 2023, 38(8): 1174-1180.
6. 骆强, 卿山林, 田中, 等. 局部枸橼酸抗凝与低分子肝素抗凝对行 CRRT 治疗脓毒症患者疗效及对凝血功能的影响. 解放军医药杂志, 2020, 32(2): 56-59.
7. Liu SY, Xu SY, Yin L, et al. Management of regional citrate anticoagulation for continuous renal replacement therapy: guideline recommendations from Chinese emergency medical doctor consensus. Mil Med Res, 2023, 10(1): 23.
8. 孙菲菲, 吉挺. 低分子肝素抗凝在连续肾脏替代治疗中的应用效果. 护理研究, 2022, 36(17): 3116-3120.
9. Clyde M, Brianne W, Kathryn D. 1327: evaluation of low- versus high-dose heparin protocols for continuous renal replacement therapy. Crit Care Med, 2024, 52(1): S635.
10. Hu ZJ, Iwama H, Suzuki R, et al. Time course of activated coagulation time at various sites during continuous haemodiafiltration using nafamostat mesilate. Intensive Care Med, 1999, 25(5): 524-527.
11. Baek NN, Jang HR, Huh W, et al. The role of nafamostat mesylate in continuous renal replacement therapy among patients at high risk of bleeding. Ren Fail, 2012, 34(3): 279-285.
12. Abe H, Tani T, Numa K, et al. Efficacy of nafamostat mesilate as a regional anticoagulant in experimental direct hemoperfusion and in plasma exchange on humans. Artif Organs, 1992, 16(2): 206-208.
13. Kamijo H, Mochizuki K, Nakamura Y, et al. Nafamostat mesylate improved survival outcomes of sepsis patients who underwent blood purification: a nationwide registry study in Japan. J Clin Med, 2020, 9(8): 2629.
14. 北村伸哉, 张凌. 甲磺酸萘莫司他在连续性肾脏替代治疗中的抗凝应用. 华西医学, 2018, 33(7): 801-805.
15. 黄美春, 庄耀宁, 陈敏敏, 等. 无肝素连续性肾脏替代治疗血液透析导管堵塞临床征象及相关因素分析. 全科护理, 2021, 19(22): 3089-3094.
16. 张丽涓, 张毅, 王玺, 等. 连续性肾脏替代疗法患者使用无肝素、普通肝素与枸橼酸钠抗凝时血小板的变化情况. 四川医学, 2013, 34(3): 326-328.
17. Dunn WJ, Sriram S. Filter lifespan in critically ill adults receiving continuous renal replacement therapy: the effect of patient and treatment-related variables. Crit Care Resusc, 2014, 16(3): 225-231.
18. Sansom B, Sriram S, Presneill J, et al. Low blood flow continuous veno-venous haemodialysis compared with higher blood flow continuous veno-venous haemodiafiltration: effect on alarm rates, filter life, and azotaemic control. Blood Purif, 2022, 51(2): 130-137.
19. Ronco C, Bellomo R, Homel P, et al. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet, 2000, 356(9223): 26-30.
20. Prowle JR, Schneider A, Bellomo R. Clinical review: optimal dose of continuous renal replacement therapy in acute kidney injury. Crit Care, 2011, 15(2): 207.
21. Yin F, Zhang F, Liu S, et al. The therapeutic effect of high-volume hemofiltration on sepsis: a systematic review and meta-analysis. Ann Transl Med, 2020, 8(7): 488.
22. Atan R, Peck L, Prowle J, et al. A double-blind randomized controlled trial of high cutoff versus standard hemofiltration in critically ill patients with acute kidney injury. Crit Care Med, 2018, 46(10): e988-e994.
23. Murugan R, Hoste E, Mehta RL, et al. Precision fluid management in continuous renal replacement therapy. Blood Purif, 2016, 42(3): 266-278.
24. Woodward CW, Lambert J, Ortiz-Soriano V, et al. Fluid overload associates with major adverse kidney events in critically ill patients with acute kidney injury requiring continuous renal replacement therapy. Crit Care Med, 2019, 47(9): e753-e760.
25. Hall A, Crichton S, Dixon A, et al. Fluid removal associates with better outcomes in critically ill patients receiving continuous renal replacement therapy: a cohort study. Crit Care, 2020, 24(1): 279.
26. Ronco C, Kaushik M, Valle R, et al. Diagnosis and management of fluid overload in heart failure and cardio-renal syndrome: the “5B” approach. Semin Nephrol, 2012, 32(1): 129-141.
27. Heise D, Faulstich M, Mörer O, et al. Influence of continuous renal replacement therapy on cardiac output measurement using thermodilution techniques. Minerva Anestesiol, 2012, 78(3): 315-321.
28. Murugan R, Ostermann M, Peng Z, et al. Net ultrafiltration prescription and practice among critically ill patients receiving renal replacement therapy: a multinational survey of critical care practitioners. Crit Care Med, 2020, 48(2): e87-e97.
29. Sansom B, Udy A, Presneill J, et al. Early net ultrafiltration during continuous renal replacement therapy: impact of admission diagnosis and association with mortality. Blood Purif, 2024, 53(3): 170-180.
30. 张莎莎, 韩代成, 刘冲冲, 等. 脓毒症休克伴急性肾损伤新生儿抗菌药物剂量调整的个体化治疗实践. 中国药师, 2022, 25(7): 1213-1217.

West China Medical Journal

Precision continuous renal replacement therapy: anticoagulation, dosage and volume management

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