지속성 신대체 요법

조현경 關東大學校 醫科大學 醫科學硏究所 2003 關東醫大學術誌 Vol.7 No.2

Intermittent hemodialysis has been used to treat patients with acute renal failure. But use of intermittent hemodialysis is less desirable in the patient who is hypotensive or hemodynamically unstable, because hypotesion is common complication of intermittent hemodialysis. For that reason, the use of continuous renal replacement therapy is increasing as alternative approach. Because major advantage of continuous renal replacement therapy is the slower rate of solute or fluid removal, continuous renal replacement therapy is generally better tolerated than intermittent hemodilaysis. There are many variations of continuous renal replacement therapy. The different modalities are categorized according to the vascular access characteristics - venovenous or arteriovenous and mechanism of solute removal - filtration, dialysis or diafiltration. In addition to being better tolerated hemodynamically, continuous renal replacement therapy is also as efficient in removing immunomodulatory substances in sepsis and allows better nutritional support. Although there are several controversies about outcome of continuous renal replacement therapy, continuous renal replacement therapy is firmly established as a modality renal replacement therapy in the ICU.

급성 신부전 환자에서 지속적 신대체요법을 이용한 마취관리 -증례 보고-

두아람 ( A Ram Doo ),장은주 ( Eun Joo Jang ),김덕규 ( Deok Kyu Kim ) 전북대학교 의과학연구소 2014 全北醫大論文集 Vol.38 No.2

The treatments for acute renal failure include recovery of renal perfusion, correction of reversible cause, normalization of plasma electrolytes and renal replacement therapy. Continuous renal replacement therapy (CRRT) is preferred to intermittent hemodialysis due to its superior hemodynamic stability with resultant effective elimination of water and toxins in critical care fields. We report a case of successful anesthetic management using CRRT in patient receiving emergent small bowel resection with acute renal failure complicated by sepsis.

Severe Hypophosphatemia-Induced Acute Toxic-Metabolic Encephalopathy in Continuous Renal Replacement Therapy

Sun Ae Han,Ha Yeol Park,Hyun Woo Kim,Jong In Choi,Da Yeong Kang,김현리,정종훈,신병철 전해질고혈압연구회 2019 Electrolytes & Blood Pressure Vol.17 No.2

Acute toxic-metabolic encephalopathy (TME) is an acute condition of global cerebral dysfunction in the absence of primary structural brain disease. Severe hypophosphatemia leads to muscle weakness and involves the diaphragm but hypophosphatemia-induced TME is very rare. Herein, we report the case of a 43-year-old woman with encephalopathy with severe hypophosphatemia during continuous renal replacement therapy. She presented with features of oliguric acute kidney injury on diabetic kidney disease due to volume depletion. At admission, her mental status was alert but gradually changed to stupor mentation during continuous renal replacement therapy. Her phosphate level was less than 0.41 mEq/L and Glasgow coma scale decreased from 15 to 5. After phosphate intravenous replacement and administration of phosphate-containing replacement solution, the phosphate level increased to 2.97 mEq/L and mental state returned to alert state. This case demonstrates that the level of phosphorus should be observed during continuous renal replacement therapy.

Cumulative fluid balance and mortality in elderly patients with acute kidney injury requiring continuous renal-replacement therapy: a multicenter prospective cohort study

( Jong Hyun Jhee ),( Jae Yoon Park ),( Jung Nam An ),( Dong Ki Kim ),( Kwon Wook Joo ),( Yun Kyu Oh ),( Chun Soo Lim ),( Yon Su Kim ),( Seung Hyeok Han ),( Tae-hyun Yoo ),( Shin-wook Kang ),( Jung Pyo 대한신장학회 2020 Kidney Research and Clinical Practice Vol.39 No.4

Background: The effect of fluid balance on outcomes in elderly patients with acute kidney injury (AKI) requiring continuous renal-replacement therapy (CRRT) is not explained well. We investigated outcomes according to cumulative fluid balance (CFB) in elderly patients with AKI undergoing CRRT. Methods: A total of 607 patients aged 65 years or older who started CRRT due to AKI were enrolled and stratified into two groups (fluid overload [FO] vs. no fluid overload [NFO]) based on the median CFB value for 72 hours before CRRT initiation. Propensity score-matching analysis was performed. Results: The median age of included patients was 73.0 years and 60.0% of the population was male. The median 72- hour CFB value was 2,839.0 mL. The overall cumulative survival and 28-day survival rates were lower in the FO group than in the NFO group (P < 0.001 for both) and remained so after propensity score-matching. Furthermore, patients in the FO group demonstrated a higher overall mortality risk after adjustment for age, sex, systolic blood pressure, Charlson comorbidity index, Acute Physiology and Chronic Health Evaluation II score, serum albumin, creatinine, diuretic use, and mechanical ventilation status (hazard ratio, 1.38; 95% confidence interval, 1.13 to 1.89; P < 0.001). Among survivors, both the duration of CRRT and the total duration of hospitalization from CRRT initiation showed no difference between the FO and NFO groups. Conclusion: A higher CFB value is associated with an increased risk of mortality in elderly patients with AKI requiring CRRT.

The Effects of Nafamostat Mesilate on a Bleeding Risk as an Anticoagulant During Use as a Continuous Renal Replacement Therapy: Systematic Review

강혜영,문수지,강영주 한국보건의료기술평가학회 2018 보건의료기술평가 Vol.6 No.2

Objectives: In the past, the pharmaceutical drug heparin was mostly used as the anticoagulant for continuous renal replacement therapy (CRRT), but the duration time is long to have the risk of a bleeding adverse effect, and in that case the drug therapy Nafamostat mesilate was utilized instead, as it is more safe in this case, with a short half-life and is increasing in use to permit lower concerns for bleeding incidents. However, there are insufficient number of large-scale studies on the comparison of Nafamostat mesilate and heparin. Methods: In this study, a systematic review are used to compare the bleeding risk of Nafamostat mesilate and Heparin, as subjected to patients and procedures for measuring risks performed with a CRRT, and the filter life span is to be evaluated as well in this patients. Results: As a result of literature review search, a total of 6 studies were included in systematic review. The reducing risk of bleeding and filter life span was analyzed. The retrospective cohort studies confirm that Nafamostat mesilate is less at risk of bleeding than heparin. And a cohort study confirms that Nafamostat mesilate is longer filter lifespan than heparin and randomized controlled trial studies show that Nafamostat mesilate is longer filter lifespan than not using the anticoagulants. Conclusion: Nafamostat mesilate is considered to be a good therapeutic option because it has a longer filter life span as well as the advantage of reducing bleeding.

Factors associated with 28-day in hospital mortality in critically ill Korean adult patients receiving continuous renal replacement therapy: A retrospective cohort study

Hyeon-Ju Lee 한국간호과학회 2023 한국간호과학회 학술대회 Vol.2023 No.11

CRRT(Continuous Renal Replacement Therapy: 지속적 신대체 요법)적용 환자의 저체온증 예방을 위한 가온요법에 관한 연구

이수진,박향숙,임은영,심유미 병원간호사회 2007 임상간호연구 Vol.13 No.3

Purpose: The purpose of this study was to investigate the effect of heated dialysate sloution(HDS) and heated replacement solution(HRS) on maintenance of the body temperature for ICU patients taking CRRT. Method: To maintain body temperature, we made the HDS and HRS using it in the peritoneal dialysis solution warmer. We measured body temperature every hour for initial 5hours after applying HDS and HRS by tympanic membrane thermometer. One hundred twenty nine of ICU patients taking CRRT were non-randomly assigned into four groups : only dialysate warmer; DW(n=33), only blood warmer; BW(n=32), DW+HDS+HRS(n=32), BW+HDS+HRS(n=32). Results: The patients' core temperature in the DW+HDS+HRS and BW+HDS+HRS groups were maintained within isothermic range. Those in the DW and BW groups significantly decreased during initial 5hours after applying CRRT<respectively, time(p=.000, p=.000)>. There was significant difference in the patients' core temperature between the DW and DW+HDS+HRS groups<group(p=.001)>. No significant difference was showed between the BW and BW+HDS+HRS groups<group (p=.093)>. Conclusion: The additional application of HDS and HRS to DW or BW may be an easy to use, and effective for maintenance of body temperature for patients on CRRT.

Laundry detergent pod: a rising cause of household poisoning

노다은 대한소아응급의학회 2020 대한소아응급의학회지 Vol.7 No.2

With the increasing use of laundry detergent pods (LDPs) in Korea, pediatricians and emergency physicians should recognize the risk of poisoning by ingestion of the pods. This report describes a 15-month-old boy who ingested an LDP at home. At the time of hospitalization, he was alert and hemodynamically stable. However, 3 hours after the ingestion, he developed drowsiness, respiratory distress, and metabolic acidosis. Despite the initial supportive therapy, the acidosis worsened, requiring continuous renal replacement therapy. Metabolic acidosis improved within 1 hour after initiation of the continuous renal replacement therapy. He was discharged uneventfully on day 13. At 1-month follow-up, he did not show any sequelae. This case highlights the need for recognition of the risk of poisoning by LDP.

Prevalence of extracorporeal blood purification techniques in critically ill patients before and during the COVID-19 pandemic in Egypt

Aya Osama Mohammed,Hanaa I. Rady 대한중환자의학회 2024 Acute and Critical Care Vol.39 No.1

Background: Extracorporeal blood-purification techniques are frequently needed in the pediatric intensive care unit (PICU), yet data on their clinical application are lacking. This study aims to review the indications, rate of application, clinical characteristics, complications, and outcomes of patients undergoing extracorporeal blood purification (i.e., by continuous renal replacement therapy [CRRT] or therapeutic plasma exchange [TPE]) in our PICU, including before the coronavirus disease 2019 (COVID-19) pandemic in 2019 and during the pandemic from 2020–2022. Methods: This study included children admitted for extracorporeal blood-purification therapy in the PICU. The indications for TPE were analyzed and compared to the American Society for Apheresis categories. Results: In 82 children, 380 TPE sessions and 37 CRRT sessions were carried out children, with 65 patients (79%) receiving TPE, 17 (20.7%) receiving CRRT, and four (4.8%) receiving both therapies. The most common indications for TPE were neurological diseases (39/82, 47.5%), followed by hematological diseases (18/82, 21.9%). CRRT was mainly performed for patients suffering from acute kidney injury. Patients with neurological diseases received the greatest number of TPE sessions (295, 77.6%). Also, the year 2022 contained the greatest number of patients receiving extracorporeal blood-purification therapy (either CRRT or TPE).Conclusions: The use of extracorporeal blood-purification techniques increased from 2019 through 2022 due to mainly autoimmune dysregulation among affected patients. TPE can be safely used in an experienced PICU. No serious adverse events were observed in the patients that received TPE, and overall survival over the 4 years was 86.5%.

난치성 부종의 치료로서 주간 간헐적 정.정맥 혈액여과법

김현철(Hyun Chul Kim) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.2

N/A Background: Refractory edema in some patients with advanced heart failure or renal failure will not respond to diuretic therapy. In this setting, the ex- cess fluid can be removed by continuous hemofiltration either by continuous arteriovenous hemofiltration (CAVH) or continuous venovenous hemofiltration (CVVH). Careful monitoring is required to prevent life-threatening hypotension due to continued production of large ultrafiltrate. To overcome these disadvantages of CVVH, we attempted to perform daytime 1VVH as an alternative therapeutic modality to CVVH. Methods: We performed venovenous hemofiltration for eight hours in the daytime in dialysis unit and repeated intermittently at 1 or 2 days interval if further treatment is required. We called this intermittent venovenous hemofiltration(IVVH). From October 1992 through November 1997, we prospectively studied the efficacy and usefulness of IVVH in 42 patients with refractory edema. Results: Underlying disorders which required IVVH were renal insufficiency in 28 patients and nephrotic syndrome in 14 patients. The mean duration of treatment was 17.0±8.4 hours. Total UFR was 26.1±153L and mean UFR/hr was 1.5±2.2L. Edema was successfully controled with only one time treatment of IVVH in 12(28.6%), two in 17(40.5%), three in 7(16.6±), four in 4(9.5±), and five in 2(4.8±), Mean number of IVVH treatments per patient was 2.2±0.4 to complete the treatment of refractory edema. Changes in blood chemistry and hemodynamics before and after IVVH were not significantly different. Body weight and abdominal girth decreased significantly after IVVH(p<0.001). No major complications occurred during these trials. There were only two episodes(5.1%) of transient hypotension, and each one episode(2.6%) of bleeding at access site and arrhythmia, respectively. Conclusion : These results stongly suggest that IVVH is a simple, safe and effective method in the treatment of refractory edema not responding to diuretic therapy.