Evaluation of continuous renal replacement therapy results applied in the intensive care unit

Yıl 2023, , 67 - 71, 31.01.2023

İlknur Hatice Akbudak , Çağla Erdoğan , İsmail Hakkı Akbudak

https://doi.org/10.31362/patd.1198297

Öz

Purpose: Acute kidney injury diagnosed patients are in need of renal replacement therapy (RRT). Continuous RRT is believed to be safer because the rates of fluid and solute removal are slower than with intermittent hemodialysis. In many centers, CRRT is preferred in special conditions such as increased cranial pressure, sepsis, burns, heart and liver failure. In our study, we present one year data of CRRT usage in our ICU.
Materials and methods: This study included the patients who admitted to the Internal Medicine Intensive Care Unit of our university between January 2019 and June 2020. Among these patients, those over 18 years of age and those who had acute renal failure during their hospitalization and received continuous renal replacement therapy were included in the study.
Results: Mean SOFA scores at admission were 2.7 which is an indication for severe disease. Lengths of ICU stay were long and approximately 77 percent of these patients died in ICU. When the comorbid conditions of the patients were examined, it was seen that oncological diseases were the most common. It was followed by hypertension, diabetes mellitus and heart diseases. Considering the KDIGO scores of the patients diagnosed with AKI, it was seen that 60 percent of them were grade 5. Treatment could be applied for an average of 25 hours.
Conclusion: Indications, timing and benefits of CRRT are the questions that need to be research and yet remained unsolved. With evolving of technology, CRRT will be our most useful helper in ICUs.

Anahtar Kelimeler

CRRT, acute kidney ınjury, renal replacement therapy, akut böbrek hasarı, renal replasman hasarı

Yoğun bakım ünitesinde uygulanan sürekli renal replasman tedavisi sonuçlarının değerlendirilmesi

Öz

Amaç: Akut böbrek hasarı teşhisi konan hastaların renal replasman tedavisine (RRT) ihtiyacı vardır. Sürekli RRT'nin daha güvenli olduğuna inanılmaktadır çünkü sıvı ve çözünen uzaklaştırma oranları aralıklı hemodiyalizden daha yavaştır. Birçok merkezde kraniyal basınç artışı, sepsis, yanıklar, kalp ve karaciğer yetmezliği gibi özel durumlarda CRRT tercih edilmektedir. Çalışmamızda yoğun bakım ünitemizde CRRT kullanımının bir yıllık verilerini sunuyoruz.
Gereç ve yöntem: Bu çalışmaya Ocak 2019-Haziran 2020 tarihleri arasında üniversitemiz Dahiliye Yoğun Bakım Ünitesi'ne başvuran hastalar dahil edilmiştir. Bu hastalardan 18 yaş üstü ve yatışı sırasında akut böbrek yetmezliği gelişen ve sürekli renal replasman tedavisi çalışmaya dahil edildi.
Bulgular: Başvuru anında ortalama SOFA skoru 2.7 idi ve bu ciddi hastalık göstergesiydi. Yoğun bakımda kalış süreleri uzundu ve bu hastaların yaklaşık yüzde 77'si yoğun bakımda öldü. Hastaların komorbid durumları incelendiğinde en sık onkolojik hastalıkların olduğu görüldü. Bunu hipertansiyon, diabetes mellitus ve kalp hastalıkları izledi. ABH tanısı alan hastaların KDIGO puanlarına bakıldığında yüzde 60'ının derece 5 olduğu görüldü. Ortalama 25 saat tedavi uygulanabildi.
Sonuç: CRRT'nin endikasyonları, zamanlaması ve faydaları, araştırılması gereken ve henüz çözülmemiş sorulardır. Gelişen teknoloji ile birlikte CRRT, yoğun bakım ünitelerinde en faydalı yardımcımız olacaktır.

Anahtar Kelimeler

CRRT, akut böbrek hasarı, renal replasman hasarı

Kaynakça

• 1. Legrand M, Darmon M, Joannidis M, Payen D. Management of renal replacement therapy in ICU patients: an international survey. Intensive Care Med. 2013;39(1):101-108. doi:10.1007/s00134-012-2706-x
• 2. Ronco C. Continuous Renal Replacement Therapy: Forty-year Anniversary. Int J Artif Organs. 2017;40(6):257-264. doi:10.5301/ijao.5000610
• 3. RENAL Replacement Therapy Study Investigators, Bellomo R, Cass A, et al. Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med. 2009;361(17):1627-1638. doi:10.1056/NEJMoa0902413
• 4. VA/NIH Acute Renal Failure Trial Network, Palevsky PM, Zhang JH, et al. Intensity of renal support in critically ill patients with acute kidney injury [published correction appears in N Engl J Med. 2009 Dec 10;361(24):2391]. N Engl J Med. 2008;359(1):7-20. doi:10.1056/NEJMoa0802639
• 5. Manns M, Sigler MH, Teehan BP. Continuous renal replacement therapies: an update. Am J Kidney Dis 1998; 32:185.
• 6. Davenport A, Honore PM. Continuous renal replacement therapy under special conditions like sepsis, burn, cardiac failure, neurotrauma, and liver failure. Semin Dial 2021; 34:457.
• 7. John A Kellum, Norbert Lameire, Peter Aspelin, Rashad S Barsoum, Emmanuel A Burdmann, et al. (2012) Kidney Disease: Improving Global Outcomes (KDIGO); Acute Kidney Injury Work Group: KDIGO clinical practice guidelines for acute kidney injury. Kidney Int Suppl 2(1): 1-138.
• 8. Investigators S-A. Canadian critical care trials G, Australian, et al. timing of initiation of renal-replacement therapy in acute kidney injury. N Engl J Med 2020; 383(3):240–51.
• 9. Maccariello E, Valente C, Nogueira L, et al. Outcomes of cancer and non-cancer patients with acute kidney injury and need of renal replacement therapy admitted to general intensive care units. Nephrol Dial Transplant. 2011;26(2):537-543. doi:10.1093/ndt/gfq441
• 10. Kim DW, Jang GS, Jung KS, et al. Hospital mortality and prognostic factors in critically ill patients with acute kidney injury and cancer undergoing continuous renal replacement therapy [published online ahead of print, 2022 Jul 19]. Kidney Res Clin Pract. 2022;10.23876/j.krcp.21.305. doi:10.23876/j.krcp.21.305
• 11. Soares M, Salluh JI, Carvalho MS, et al. Prognosis of critically ill patients with cancer and acute renal dysfunction, J Clin Oncol, 2006, vol. 24 (pg. 4003-4010)
• 12. Kovvuru K, Velez JCQ. Complications associated with continuous renal replacement therapy. Semin Dial. 2021;34(6):489-494. doi:10.1111/sdi.12970