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This page shows you the latest news and research items in this category.

Renal Protective Effects of Early Continuous Venovenous Hemofiltration in Rhabdomyolysis: Improved Renal Mitochondrial Dysfunction and Inhibited Apoptosis
Abstract Rhabdomyolysis (RM) and subsequent myoglobin (Mb) deposition can lead to acute kidney injury. Continuous venovenous hemofiltration (CVVH) can remove Mb, but direct renal protection is unclear. We hypothesized that CVVH can improve renal mitochondrial dysfunction in its early stage. Twenty‐four mongrel dogs were randomly divided into four groups: (A) control; (B) model; (C) model + CVVH (50 mL/kg/h); and (D) model + CVVH (30 mL/kg/h). RM was induced by glycerol via intramuscular injection. The dogs were closely monitored for urine flow and renal function. Mb, plasma tumor necrosis factor‐α (TNF‐�...
Source: Artificial Organs - February 27, 2013 Category: Transplant Surgery Authors: Wanxin Tang, Zejun Chen, Weihua Wu, Hongyu Qiu, Hong Bo, Ling Zhang, Ping Fu Tags: Main Text Article Source Type: research

Anaphylactoid reaction during first hemofiltration with a PUREMA® polysulfone membrane.
We present a case of a 34 year old woman in the Burn Intensive Care Unit, who developed acute kidney injury requiring renal replacement therapy. She was placed on continuous veno-venous hemofiltration with the NxStage® machine which uses a synthetic PUREMA® polyethersulfone filter sterilized by gamma radiation. Within two minutes of initiating hemofiltration, the patient complained of pruritus as well as dyspnea and became flushed and agitated. She subsequently developed hypotension ultimately resulting in cardiopulmonary arrest. Cardiopulmonary resuscitation was initiated and the patient was given epinephrine with retur...
Source: The International Journal of Artificial Organs - February 19, 2013 Category: Transplant Surgery Authors: Heegard KD, Tilley MA, Stewart IJ, Edgecombe HP, Lundy JB, Renz EM, Chung KK Tags: Int J Artif Organs Source Type: research

Vancomycin Clearance in High-Volume Venovenous Hemofiltration (March).
CONCLUSIONS:An initial vancomycin dose of 20-25 mg/kg with frequent monitoring and adjustment is recommended for patients receiving high-volume CVVH. PMID: 23404801 [PubMed - as supplied by publisher] (Source: The Annals of Pharmacotherapy)
Source: The Annals of Pharmacotherapy - February 12, 2013 Category: Drugs & Pharmacology Authors: Paciullo CA, Harned KC, Davis GA, Connor MJ, Winstead PS Tags: Ann Pharmacother Source Type: research

Unsuspected Iatrogenic Vertebral Artery Cannulation With a Dialysis Catheter
Internal jugular vein cannulation is a common clinical procedure but not without risks including inadvertent artery puncture. The incidence of vertebral artery puncture during internal jugular vein cannulation is unclear but is thought to be much less than carotid artery involvement. Here, we describe an unsuspected case of vertebral artery cannulation with a Vas Cath dialysis catheter which was used for hemofiltration before the inadvertent artery cannulation was discovered later during open surgical retrieval. (Source: Vascular and Endovascular Surgery)
Source: Vascular and Endovascular Surgery - February 6, 2013 Category: Surgery Authors: Lim, C. S., Nott, D. M. Tags: Case Reports Source Type: research

Assessment of ventricular contractility and ventricular-arterial coupling with a model-based sensor
Highlights: ► We use of a model to assess ventricular arterial coupling in septic shock. ► The model-based right ventricular elastance correlates with the clinical gold standard. ► The model-based non-invasive coupling follows the same trends and dynamics. ► Potential to develop a sensor to monitor the coupling in clinical real-time.Abstract: Estimation of ventricular contractility and ventricular arterial coupling is clinically important in diagnosing and treating cardiac dysfunction in the critically ill. However, experimental assessment of indexes of ventricular contractility, such as the end-systolic pressure�...
Source: Computer Methods and Programs in Biomedicine - February 1, 2013 Category: Bioinformatics Authors: Thomas Desaive, Bernard Lambermont, Nathalie Janssen, Alexandre Ghuysen, Philippe Kolh, Philippe Morimont, Pierre C. Dauby, Christina Starfinger, Geoffrey M. Shaw, J. Geoffrey Chase Source Type: research

What factors need to be considered when dosing patients on renal replacement therapies?
Source: South West Medicines Information and Training Area: Evidence > Medicines Q & A There are a number of factors that need to be considered when dosing patients on renal replacement therapy (RRT). Consider the drug, the patient and the type of RRT. Alteration of drug dosage is only necessary if renal clearance exceeds 25% of total body clearance. Drugs which are cleared by the kidneys are usually dialysed, and vice versa, although there are some anomalies. Dose adjustment for RRT is only necessary for drugs that require dose adjustment because of the presence of renal failure. No RRT is as effective as the n...
Source: NeLM - Medicines Q and A - January 22, 2013 Category: Drugs & Pharmacology Source Type: news

Hydrodynamic Analysis of the Miniaturized Hemofilter for a Wearable Ultrafiltration Device
Blood Purif 2013;35:127–132 (DOI:10.1159/000346098) (Source: Blood Purification)
Source: Blood Purification - January 21, 2013 Category: Hematology Source Type: research

Studying the therapeutic effects of hemoperfusion with continuous venovenous hemofiltration in paraquat-poisoned patients by the ratio of residual normal lung in 3D-CT image
No description available (Source: BioMed Central)
Source: BioMed Central - December 18, 2012 Category: Journals (General) Authors: Liu PengZhang Hong-taoLiang Yu-guangHe JinLi Yue-qiLi Gong-jieZhou Yue-su Source Type: research

Intermittent high-volume predilution on-line haemofiltration versus standard intermittent haemodialysis in critically ill patients with acute kidney injury: a prospective randomized study
Conclusions Dialysis treatment with intermittent high-volume predilution on-line HF in critically ill patients with AKI did not decrease mortality, improve recovery of kidney function or reduce the need for dialysis support compared to standard intermittent HD. (Source: Nephrology Dialysis Transplantation)
Source: Nephrology Dialysis Transplantation - December 12, 2012 Category: Urology & Nephrology Authors: Skofic, N., Arnol, M., Buturovic-Ponikvar, J., Ponikvar, R. Tags: Acute Kidney Injury Source Type: research

Biochemical Effects of Phosphate-Containing Replacement Fluid for Continuous Venovenous Hemofiltration
Blood Purif 2012;34:306–312 (DOI:10.1159/000345343) (Source: Karger Publishers)
Source: Karger Publishers - December 11, 2012 Category: Cancer & Oncology Source Type: research

Molecular Adsorbent Recirculating System (MARS®) removal of piperacillin/tazobactam in a patient with acetaminophen‐induced acute liver failure
The objective of this study was to illustrate the pharmacokinetic removal of piperacillin/tazobactam in an anuric patient on Molecular Adsorbent Recirculating System (MARS®). The patient was a 32‐year‐old woman who presented to a medical intensive care unit with acute liver failure secondary to an acetaminophen overdose. While awaiting transplant, she was started on MARS therapy as a bridge to liver transplant and empirically started on piperacillin/tazobactam therapy. MARS is an extracorporeal hemofiltration device, which incorporates a continuous venovenous hemofiltration (CVVHD) machine linked to an albumin‐enric...
Source: Transplant Infectious Disease - December 1, 2012 Category: Transplant Surgery Authors: M.A. Ruggero, A.C. Argento, M.S. Heavner, J.E. Topal Tags: Short communication Source Type: research

Predictors for Early and Late Outcomes After Coronary Artery Bypass Grafting in Hemodialysis Patients [ORIGINAL ARTICLES: ADULT CARDIAC]
Conclusions Although early outcomes have been improved by off-pump techniques, late outcomes are not satisfactory in patients who rely on HD and undergo CABG. To improve late outcomes we may need aggressive management of DM, PAD, and low LVEF in those patients. (Source: The Annals of Thoracic Surgery)
Source: The Annals of Thoracic Surgery - November 27, 2012 Category: Cardiovascular & Thoracic Surgery Authors: Takami, Y., Tajima, K., Kato, W., Fujii, K., Hibino, M., Munakata, H., Sakai, Y. Tags: Coronary disease ORIGINAL ARTICLES: ADULT CARDIAC Source Type: research

An open prospective study of amikacin pharmacokinetics in critically ill patients during treatment with continuous venovenous haemodiafiltration
Conclusions: CVVHDF contributes significantly to total clearance of amikacin. The use of pharmacokinetic parameter estimates obtained from two steady state serum-drug concentrations (peak and trough) can be used to guide individualised dosing of critically ill patients treated with CVVHDF. This is considered a useful strategy in this patient cohort, particularly in avoiding the risk of underdosing. (Source: BMC Clinical Pharmacology)
Source: BMC Clinical Pharmacology - November 8, 2012 Category: Drugs & Pharmacology Authors: Deirdre D¿ArcyEoin CaseyCaitriona GowingMaria DonnellyOwen Corrigan Source Type: research

Effect of a plasma sodium biofeedback system applied to HFR on the intradialytic cardiovascular stability. Results from a randomized controlled study
Conclusions HFR-Aeq, a profiled dialysis supported by the Natrium sensor for the pre-dialysis Na+ measure, can significantly reduce the burden of IDH. This could have an important impact in every day dialysis practice. (Source: Nephrology Dialysis Transplantation)
Source: Nephrology Dialysis Transplantation - October 31, 2012 Category: Transplant Surgery Authors: Locatelli, F., Stefoni, S., Petitclerc, T., Coli, L., Di Filippo, S., Andrulli, S., Fumeron, C., Frasca, G. M., Sagripanti, S., Savoldi, S., Serra, A., Stallone, C., Aucella, F., Gesuete, A., Scarlatella, A., Quarello, F., Mesiano, P., Ahrenholz, P., Wink Tags: Intra- and Extracorporeal Treatments of Kidney Failure Source Type: research

Optimal Mode of clearance in critically ill patients with Acute Kidney Injury (OMAKI) - a pilot randomized controlled trial of hemofiltration versus hemodialysis: a Canadian Critical Care Trials Group project
Conclusions: Our results suggest that a large trial comparing CVVH to CVVHD would be feasible. There is a trend toward improved vasopressor requirements among CVVH-treated patients over the first week of treatment.Trial registration: ClinicalTrials.gov NCT00675818. (Source: Critical Care)
Source: Critical Care - October 24, 2012 Category: Intensive Care Authors: Ron WaldJan FriedrichSean BagshawKaren BurnsAmit GargMichelle HladunewichAndrew HouseStephen LapinskyDavid KleinNeesh PannuKaren PopeRobert RichardsonKevin ThorpeNeill Adhikari Source Type: research

Continuous Hemodiafiltration with a Cytokine-Adsorbing Hemofilter for Sepsis
Blood Purif 2012;34:164–170 (DOI:10.1159/000342379) (Source: Blood Purification)
Source: Blood Purification - October 23, 2012 Category: Hematology Source Type: research

Bivalirudin Versus Heparin as an Anticoagulant During Extracorporeal Membrane Oxygenation: A Case-Control Study
Conclusions: Bivalirudin-based anticoagulation may represent a new method of anticoagulation for reducing thromboembolic and bleeding complications, which still jeopardize the application of extracorporeal membrane oxygenation. Moreover, bivalirudin is free from the risk of heparin-induced thrombocytopenia. Higher doses of bivalirudin may be needed in patients undergoing hemofiltration. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - October 2, 2012 Category: Anesthesiology Authors: Marina Pieri, Natalia Agracheva, Enrico Bonaveglio, Teresa Greco, Michele De Bonis, Remo Daniel Covello, Alberto Zangrillo, Federico Pappalardo Tags: Original Articles Source Type: research

Impact of gentamicin-collagen sponge (collatamp) on the incidence of sternal wound infection in high-risk cardiac surgery patients: a propensity score analysis.
Conclusion: Gentamicin-containing collagen sponge (Collatamp) is a useful adjunct to meticulous surgical technique and postoperative wound care in reducing the incidence of sternal wound infection in high-risk cardiac surgery patients. An adequately powered study is needed, however, to validate the safety and efficacy of this strategy. PMID: 23092661 [PubMed - in process] (Source: The Heart Surgery Forum)
Source: The Heart Surgery Forum - October 1, 2012 Category: Cardiovascular & Thoracic Surgery Authors: Raja SG, Salhiyyah K, Rafiq MU, Felderhof J, Amrani M Tags: Heart Surg Forum Source Type: research

Mitral valve repair for severe mitral regurgitation secondary to lone atrial fibrillation [ADULT CARDIAC]
CONCLUSIONS MV annuloplasty for annular dilatation secondary to AF has a good mid-term outcome. (Source: European Journal of Cardio-Thoracic Surgery)
Source: European Journal of Cardio-Thoracic Surgery - October 1, 2012 Category: Cardiovascular & Thoracic Surgery Authors: Vohra, H. A., Whistance, R. N., Magan, A., Sadeque, S. A., Livesey, S. A. Tags: ADULT CARDIAC Source Type: research

Effect of anticoagulation regimens on handling of interleukin-6 and -8 during continuous venovenous hemofiltration in critically ill patients with acute kidney injury.
CONCLUSIONS: Blood to membrane contact, adsorption/clearance and anticoagulation do not increase nor attenuate high circulating levels of IL-6 and IL-8 during CVVH for AKI. This renders the hypothesis that the reported survival benefit for citrate anticoagulation is based on a reduction of bioincompatibility unlikely. PMID: 23006672 [PubMed - as supplied by publisher] (Source: Cytokine)
Source: Cytokine - September 21, 2012 Category: Molecular Biology Authors: Schilder L, Azam Nurmohamed S, Ter Wee PM, Girbes AR, Beishuizen A, Paauw NJ, Beelen RH, Johan Groeneveld AB Tags: Cytokine Source Type: research

A Case of Sodium Chlorite Toxicity Managed with Concurrent Renal Replacement Therapy and Red Cell Exchange.
We report the presentation and management of a single case of human toxicity of sodium chlorite. CASE REPORT: A 65-year-old man presented to hospital after accidentally ingesting a small amount of a sodium chlorite solution. His principal manifestations were mild methemoglobinemia, severe oxidative hemolysis, disseminated intravascular coagulation, and anuric acute kidney injury. He was managed with intermittent hemodialysis, followed by continuous venovenous hemofiltration for management of acute kidney injury and in an effort to remove free plasma chlorite. Concurrently, he underwent two re...
Source: Journal of Medical Toxicology - September 21, 2012 Category: Toxicology Authors: Romanovsky A, Djogovic D, Chin D Tags: J Med Toxicol Source Type: research

Colistin pharmacokinetics in intensive care unit patients on continuous venovenous haemodiafiltration: an observational study
Conclusions In spite of substantial extracorporeal clearance, total colistin clearance was reduced, compared with patients with normal renal function. Colistin adsorption by the haemofilter contributed to its extracorporeal clearance to a large extent. Studies on other patients receiving colistin methane sulphonate and undergoing CRRT are required before more appropriate dosage regimens can be recommended. (Source: Journal of Antimicrobial Chemotherapy)
Source: Journal of Antimicrobial Chemotherapy - September 17, 2012 Category: Microbiology Authors: Markou, N., Fousteri, M., Markantonis, S. L., Zidianakis, B., Hroni, D., Boutzouka, E., Baltopoulos, G. Tags: Original research Source Type: research

Effect of Continuous Venovenous Hemofiltration Dose on the Achievement of Adequate Vancomycin Trough Concentrations.
Abstract The vancomycin dose necessary for the achievement of target serum trough concentrations during continuous venovenous hemofiltration (CVVH) remains to be elucidated. This was a retrospective cohort study of critically ill adults at a tertiary medical center on concurrent CVVH and vancomycin between 2006 and 2010 with a steady state vancomycin trough concentration. The 87 included patients were grouped according to low (≤ 30 mL/kg/h; N = 10) or high (> 30 mL/kg/h; N = 77) CVVH hemofiltration rate (HFR) for analysis. Vancomycin goal trough achievement occurred in only 32 (37%) patients. The primary endpo...
Source: Antimicrobial Agents and Chemotherapy - September 17, 2012 Category: Microbiology Authors: Frazee EN, Kuper PJ, Schramm GE, Larson SL, Kashani KB, Osmon DR, Leung N Tags: Antimicrob Agents Chemother Source Type: research

Intracranial Hemorrhage and a White Blood Cell Count of Almost 1 Million Cells/μL
A 2-year-old boy with respiratory difficulty and altered mental status was intubated and transferred to our hospital. Examination revealed fever (39.5°C), hypertension (110/76 mmHg), and sinus tachycardia (140 beats/minute). He appeared pale with abundant petechiae and purpurae; was unresponsive to verbal, tactile, or painful stimuli; and exhibited decerebrate posturing and a “blown” left pupil. Laboratory studies detected profound leukocytosis (white blood cell [WBC] count 966 200 cells/μL) with 93% blasts, anemia (hemoglobin 7.4 g/dL), thrombocytopenia (platelets 42 000/dL), and a prothrombin time of 25.7 seconds (...
Source: The Journal of Pediatrics - September 3, 2012 Category: Pediatrics Authors: John L. Colquitt, John A. D'Orazio Tags: Insights and Images Source Type: research

High‐Volume Hemofiltration Reduces the Expression of Myocardial Tumor Necrosis Factor‐Alpha in Septic Shock Pigs
Abstract Increasing evidence indicates that the expression of tumor necrosis factor‐α (TNF‐α) in myocardium correlates with the severity of cardiac dysfunction in septic shock. The aim of this study was to investigate the impact of high‐volume hemofiltration (HVHF) on the expression of TNF‐α in myocardium in septic shock pigs. Sixteen male Landrace pigs weighing 31 ± 5 kg were randomly assigned to control group (n = 4), septic shock group (n = 6), and HVHF group (septic shock + HVHF, n = 6). All animals were anesthetized and mechanically ventilated. After baseline examinations, septic shoc...
Source: Artificial Organs - September 1, 2012 Category: Transplant Surgery Authors: Chunmei Li, Ping Zhang, Xiuju Cheng, Jianghua Chen Source Type: research

Predictors of haemoglobin levels and resistance to erythropoiesis-stimulating agents in patients treated with low-flux haemodialysis, haemofiltration and haemodiafiltration: results of a multicentre randomized and controlled trial
Conclusions In comparison with low-flux HD, CTs did not significantly improve Hb levels or ESA resistance. The main sources of variability were participating centres, ESA dose and the underlying disease. (Source: Nephrology Dialysis Transplantation)
Source: Nephrology Dialysis Transplantation - August 31, 2012 Category: Urology & Nephrology Authors: Locatelli, F., Altieri, P., Andrulli, S., Sau, G., Bolasco, P., Pedrini, L. A., Basile, C., David, S., Feriani, M., Nebiolo, P. E., Ferrara, R., Casu, D., Logias, F., Tarchini, R., Cadinu, F., Passaghe, M., Fundoni, G., Villa, G., Di Iorio, B. R., Zoccali Tags: Intra- and Extracorporeal Treatments of Kidney Failure Source Type: research

Treatment of critically ill children with kidney injury by sustained low-efficiency daily diafiltration
Conclusions This pilot investigation demonstrates that SLEDD-f provides good hemodynamic tolerance and correction of fluid overload, pH, and electrolyte imbalance for critically ill children with AKI. Content Type Journal ArticleCategory Original ArticlePages 1-9DOI 10.1007/s00467-012-2254-1Authors Chia-Ying Lee, Division of Pediatric Nephrology, Children’s Medical Center, China Medical University Hospital, China Medical University, Taichung, TaiwanHuang-Chieh Yeh, Division of Nephrology, Department of Medicine, China Medical University and Hospital, Taichung, TaiwanChing-Yuang Lin, Division of Ped...
Source: Pediatric Nephrology - August 17, 2012 Category: Urology & Nephrology Tags: Pediatric Nephrology Source Type: research

Superb review of hemodialysis and other enhanced elimination techniques
4.5 out of 5 stars Extracorporeal Removal Techniques for the Poisoned Patient: A Review for the Intensivist. Fertel BS et al. J Intensive Care Med 2010 May-June;25:139-148. Abstract I missed this must-read paper when it was published over 2 years ago, but am delighted I finally caught up with it. I reviewed articles on extracorporeal removal (ECR) techniques in toxicology cases while preparing a 2010 Emergency Medicine News column on the topic, and this paper is by far the best thing I’ve seen on the topic. The authors (Baruck Fertel, Lewis Nelson, and David Goldfarb) represent emergency medicine, medical toxicol...
Source: The Poison Review - August 16, 2012 Category: Toxicology Authors: Leon Tags: Medical aspirin continuous hemofiltration CRRT CVVH ethylene glycol extracorporeal removal techniques hemodiafiltration hemodialysis hemoperfusion lithium methanol poisoning salicylate toxic alcohol toxicity valproate val Source Type: news

Effects of Large‐Pore Hemofiltration in a Swine Model of Fulminant Hepatic Failure
In this study, the authors used a validated ischemic FHF swine model to evaluate the effects of 80 kDa large‐pore membrane hemofiltration (LPHF) on intracranial pressure (ICP) and CBF, in relation with the clearance of proinflammatory cytokines and blood liver tests, as primary end points. Fifteen pigs were randomized into one of three groups: SHAM, FHF, and FHF + LPHF. All experiments lasted 6 h. In the FHF groups, liver failure was induced by liver ischemia. After 2 h, the FHF + LPHF group underwent 4 h of a zero‐balance continuous veno‐venous hemofiltration using a 0.7‐m2, large‐pore (78 Å) ...
Source: Artificial Organs - August 14, 2012 Category: Transplant Surgery Authors: Olivier Detry, Nathalie Janssen, Jean‐Paul Cheramy‐Bien, Etienne Cavalier, Jean‐Olivier Defraigne, Pierre Delanaye, Bernard Lambermont Source Type: research

Fatal manganese intoxication due to an error in the elaboration of Epsom salts for a liver cleansing diet
We describe the case of a 50-year-old man with a fatal intoxication after accidental massive oral ingestion of manganese. The patient presented with lethargy, diffuse abdominal pain, vomiting, and profuse diarrhea after ingesting Epsom salts (magnesium sulfate heptahydrate) during a liver cleansing diet. Despite intensive care management with intubation, prone position ventilation, continuous venovenous hemofiltration, and multiple transfusions, he progressed to refractory shock with multiple organ dysfunction resulting in death within 72h. Similar patients arrived at several hospitals with identical epidemiology (all had ...
Source: Forensic Science International - August 13, 2012 Category: Forensic Medicine Authors: Baltasar Sánchez, Jaume Casalots-Casado, Salvador Quintana, Amparo Arroyo, Carles Martín-Fumadó, Ignasi Galtés Tags: Case Reports Source Type: research

Hemofiltration or hemodialysis for acute kidney injury?
The optimal choice of modality for acute renal replacement therapy (RRT) is presently unclear. Diffusive therapy (hemodialysis) mainly removes small solutes whilst convective therapies (hemofiltration and hemodiafiltration) may also eliminate larger molecules such as myoglobin or cytokines. Conversely, convective therapies might predispose to filter clotting and thus increased costs. A systematic review and meta-analysis of clinical trials could not find evidence for clinical benefits of either modality. Thus, the decision on RRT modality remains to be based on the individual patient's clinical status, medical and nursing ...
Source: BioMed Central - August 10, 2012 Category: Journals (General) Authors: Achim Jörres Source Type: research

[Study of factors affecting drug extraction during continuous hemofiltration and hemodiafiltration, and the contribution of extraction to systemic clearance].
Abstract The aim of this study was to elucidate the factors affecting dialysis clearance and the need for additional doses of drugs during and after continuous hemofiltration (CHF) and hemodiafiltration (CHDF). We performed a literature search of MEDLINE using the terms hemofiltration OR hemodiafiltration AND pharmacokinetics to obtain the clearances of CHF and CHDF in a clinical setting. The relationships between molecular weight, the unbound fraction (fuB), ultrafiltration flow rate (UFR) and dialysis flow rate were analyzed. The need for additional doses of certain drugs was also discussed based on the ratio of ...
Source: Yakugaku Zasshi : Journal of the Pharmaceutical Society of Japan - August 8, 2012 Category: Drugs & Pharmacology Authors: Suzuki F, Hanada K, Motoki M, Ogata H Tags: Yakugaku Zasshi Source Type: research

Regional citrate anticoagulation in CVVH: A new protocol combining citrate solution with a phosphate‐containing replacement fluid
Abstract Regional citrate anticoagulation (RCA) is a valid anticoagulation method in continuous renal replacement therapies (CRRT) and different combination of citrate and CRRT solutions can affect acid‐base balance. Regardless of the anticoagulation protocol, hypophosphatemia occurs frequently in CRRT. In this case report, we evaluated safety and effects on acid‐base balance of a new RCA‐ continuous veno‐venous hemofiltration (CVVH) protocol using an 18 mmol/L citrate solution combined with a phosphate‐containing replacement fluid. In our center, RCA‐CVVH is routinely performed with a 12 mmol/L citrate sol...
Source: Hemodialysis International - August 7, 2012 Category: Hematology Authors: Santo Morabito, Valentina Pistolesi, Luigi Tritapepe, Laura Zeppilli, Francesca Polistena, Enrico Fiaccadori, Alessandro Pierucci Tags: Case Report Source Type: research

Hemofiltration compared to hemodialysis for acute kidney injury: systematic review and meta-analysis
Conclusions: Data from small RCTs do not suggest beneficial clinical outcomes from hemofiltration, but confidence intervals were wide. Hemofiltration may increase clearance of medium to larger molecules. Larger trials are required to evaluate effects on clinical outcomes. (Source: Critical Care)
Source: Critical Care - August 6, 2012 Category: Intensive Care Authors: Jan FriedrichRon WaldSean BagshawKaren BurnsNeill Adhikari Source Type: research

Clinical Effects of Pulse High‐Volume Hemofiltration on Severe Acute Pancreatitis Complicated With Multiple Organ Dysfunction Syndrome
Abstract To evaluate the effects of pulse high‐volume hemofiltration (PHVHF) on severe acute pancreatitis (SAP) with multiple organ dysfunction syndrome (MODS). Thirty patients were divided into two groups: PHVHF group and continuous venovenous hemofiltration (CVVH) group. They were evaluated in terms of clinical symptoms, acute physiology and chronic health evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score, simplified acute physiology (SAPS) II score and biochemical changes. The levels of IL‐6, IL‐10 and TNF‐α in plasma were assessed by ELISA before and after treatment. The doses of d...
Source: Therapeutic Apheresis and Dialysis - August 1, 2012 Category: Hematology Authors: La‐Ping Chu, Jun‐Jing Zhou, Ya‐Fen Yu, Yang Huang, Wen‐Xia Dong Source Type: research

Autologous creatinine clearance in a case of necrotizing fasciitis and anuria.
We present the case of a patient with necrotizing fasciitis who endured 31 consecutive days of complete anuria. His serum creatinine decreased over this interval without the use of extracorporeal hemofiltration or dialysis. The explanation for this novel phenomenon lies in massive daily sero-sanguineous discharge and insensible losses with subsequent volume resuscitation. The patient's own convective clearance was substantial enough to maintain a modest creatinine clearance of 15 ml/min during sustained anuria. Our case emphasizes the importance of employing the creatinine, estimated glomerular filtration rate, and urine o...
Source: American Journal of Nephrology - July 28, 2012 Category: Urology & Nephrology Authors: Eadon MT, Koyner JL Tags: Am J Nephrol Source Type: research

Sustained low efficiency dialysis using a single-pass batch system in acute kidney injury - a randomized interventional trial: the REnal Replacement Therapy Study in Intensive Care Unit PatiEnts
IntroductionAcute kidney injury (AKI) is associated with a high mortality of up to 60%. The mode of renal replacement therapy (intermittent versus continuous) has no impact on patient survival. Sustained low efficiency dialysis using a single-pass batch dialysis system (SLED-BD) has recently been introduced for the treatment of dialysis-dependent AKI. To date, however, only limited evidence is available in the comparison of SLED-BD versus continuous veno-venous hemofiltration (CVVH) in intensive care unit (ICU) patients with AKI. Methods: Prospective, randomized, interventional, clinical study at a surgical intensive care ...
Source: Critical Care - July 27, 2012 Category: Intensive Care Authors: Vedat SchwengerMarkus WeigandOskar HoffmannRalf DikowLars KihmJorg SeckingerNexhat MiftariMatthias SchaierStefan HoferCaroline HaarPeter NawrothMartin ZeierEike MartinChristian Morath Source Type: research

Raised serum cardiac troponin I concentrations predict hospital mortality in intensive care unit patients
Conclusions Increased serum cTnI concentrations during ICU stay independently predicts hospital mortality, even when the threshold is low. We found a trend towards an association between ‘minor’ elevations in cTnI and higher in-hospital mortality. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - July 10, 2012 Category: Anesthesiology Authors: Reynolds, T., Cecconi, M., Collinson, P., Rhodes, A., Grounds, R. M., Hamilton, M. A. Tags: Critical Care Source Type: research

Does the surface-treated AN69 membrane prolong filter survival in CRRT without anticoagulation?
Conclusions Compared with the original AN69 membrane, the surface-treated AN69ST membrane does not prolong filter survival during CVVH without systemic anticoagulation and with the CRRT settings used in this study. Content Type Journal ArticleCategory OriginalPages 1-8DOI 10.1007/s00134-012-2633-xAuthors Miet Schetz, Department of Intensive Care Medicine, University Hospital of the Catholic University Leuven, Herestraat 49, 3000 Leuven, BelgiumSophie Van Cromphaut, Department of Intensive Care Medicine, University Hospital of the Catholic University Leuven, Herestraat 49, 3000 Leuven, BelgiumJasperin...
Source: Intensive Care Medicine - July 6, 2012 Category: Intensive Care Tags: Intensive Care Medicine Source Type: research

Locum Consultant in Paediatric Intensive Care, Cambridge, UK
Via www.healthjobsuk.com. Applications are invited to apply for the post of locum consultant in paediatric intensive care at Addenbrooke’s Hospital, Cambridge, UK to take up appointment on 1 August 2012 for a period of 12 months in the first instance. The PICU at Addenbrooke’s Hospital offers specialist care for children admitted with neurosurgical problems including trauma and support for co-located paediatric subspecialties which include endocrinology and diabetes, haematology and oncology, neurology, gastroenterology, respiratory, spinal surgery, general surgery and cleft/lip and palate surgery. While ...
Source: Society for Endocrinology - July 2, 2012 Category: Endocrinology Source Type: news

Treatment of medically refractory hypercalcemic crisis.
Conclusions: This is the first case of hypercalcemia treated with CVVH with epoprostenol anticoagulation. This method avoids some of the pitfalls of using intermittent hemodialysis. It is also a rare example of hypercalcemia induced posterior reversible encephalopathy syndrome (PRES). PMID: 22476881 [PubMed - in process] (Source: The International Journal of Artificial Organs)
Source: The International Journal of Artificial Organs - July 1, 2012 Category: Transplant Surgery Authors: Au S, Dunham M, Godinez T Tags: Int J Artif Organs Source Type: research

Regional citrate anticoagulation in cardiac surgery patients at high risk of bleeding: a continuous veno-venous hemofiltration protocol with a low concentration citrate solution
IntroductionRegional citrate anticoagulation (RCA) is a valid option in patients at high risk of bleeding and undergoing continuous renal replacement therapy (CRRT). The aim was to evaluate, in critically ill patients with severe acute kidney injury following cardiac surgery, the efficacy and safety of RCA- continuous veno-venous hemofiltration (CVVH) using a low concentration citrate solution. Methods: In high bleeding risk cardiac surgery patients, we adopted, as alternative to heparin or no anticoagulation, RCA-CVVH using a 12 mmol/l citrate solution. For RCA-CVVH settings, we developed a mathematical model to roughly e...
Source: Critical Care - June 27, 2012 Category: Intensive Care Authors: Santo MorabitoValentina PistolesiLuigi TritapepeLaura ZeppilliFrancesca PolistenaEmanuela StrampelliAlessandro Pierucci Source Type: research

Myoglobin clearance by continuous venous–venous haemofiltration in rhabdomyolysis with acute kidney injury: Reply to Letter
We would like to thank Dr. Violo and his coauthors for their interest in our recent article published in Injury titled “Myoglobin clearance by continuous venous–venous haemofiltration in rhabdomyolysis with acute kidney injury: a case series”. We completely agree with Dr. Violo that myoglobin metabolism, kinetics, and body distribution are still not well defined, and we also admitted in our article that we could not explain the direct relation between the decrease of serum myoglobin and removal by CVVH because of endogenous clearance rate for myoglobin. Besides, concerning the protein coat, we also agree that the hae...
Source: Injury - June 20, 2012 Category: Orthopaedics Authors: Ling Zhang, Yi Tang, Yingying Yang, Ping Fu Tags: Correspondence Source Type: research

CA.R.PE.DI.E.M. (Cardio–Renal Pediatric Dialysis Emergency Machine): evolution of continuous renal replacement therapies in infants. A personal journey
We describe here the evolution of pediatric RRT during the last 30 years and report in detail on the CARPEDIEM project, which has recently been established to finally provide neonates and infants with a reliable dialysis machine that is specifically designed for this age group. Content Type Journal ArticleCategory Editorial CommentaryPages 1-9DOI 10.1007/s00467-012-2179-8Authors Claudio Ronco, Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute Vicenza, San Bortolo Hospital, Viale Rodolfi 36100, Vicenza, ItalyFrancesco Garzotto, Department of Nephrology, Dialysis and Tran...
Source: Pediatric Nephrology - May 26, 2012 Category: Urology & Nephrology Tags: Pediatric Nephrology Source Type: research

High-volume Hemofiltration in the Intensive Care Unit: A Blood Purification Therapy
High-volume hemofiltration is an extracorporeal therapy that has been available in the intensive care unit for more than 10 yr. Recent improvements in technology have made its clinical application easier and safer. However, the definition, indications, and management of this technique are still unclear, and considerable controversy and confusion remain. The aim of this review is to analyze the available data while taking into account the distinction between two very different clinical situations: acute kidney injury requiring renal support, and severe inflammatory states where blood purification has been suggested as an ad...
Source: Anesthesiology - May 22, 2012 Category: Anesthesiology Tags: Education: Review Article Source Type: research

Complications and Toxicity After Abdominal and Pelvic Hypoxic Stop-Flow Perfusion Chemotherapy: Incidence and Assessment of Risk Factors
Conclusions In the present series, abdominal and pelvic SFP was associated with an acceptable morbidity, which was mostly mild or moderate. Abdominal procedures were associated with increased toxicity. This procedure seems to be repeatable and also well tolerated both by elderly patients and by patients who had undergone prior chemotherapy and/or radiotherapy, while hemofiltration does not appear to decrease the incidence of systemic toxicity. Content Type Journal ArticleCategory Pancreatic TumorsPages 1-7DOI 10.1245/s10434-012-2383-6Authors Eelco de Bree, Department of Surgical Oncology, Medical S...
Source: Annals of Surgical Oncology - May 11, 2012 Category: Cancer & Oncology Tags: Annals of Surgical Oncology Source Type: research

Spontaneous retroperitoneal hemorrhage after hemodialysis involving anticoagulant agents.
Abstract In this paper, we described the symptoms and treatment of a patient with diabetic nephropathy accompanied by spontaneous retroperitoneal hemorrhage after hemodialysis. An elderly female patient with diabetic nephropathy presented with severe pain, numbness, and an increasing swelling in the left hip and left thigh after six sessions of hemodialysis involving the use of an antiplatelet drug and an anticoagulant agent. Her hemoglobin decreased to 46 g/L. An abdominal ultrasound showed a hematoma in the left retroperitoneal space, and computed tomography (CT) findings revealed a 6 cm×8 cm×10 cm hematoma in ...
Source: J Zhejiang Univ Sci ... - May 1, 2012 Category: Science Authors: Fan WX, Deng ZX, Liu F, Liu RB, He L, Amrit B, Zang L, Li JW, Liu XR, Huang SM, Fu P Tags: J Zhejiang Univ Sci B Source Type: research

Spontaneous retroperitoneal hemorrhage after hemodialysis involving anticoagulant agents.
Abstract In this paper, we described the symptoms and treatment of a patient with diabetic nephropathy accompanied by spontaneous retroperitoneal hemorrhage after hemodialysis. An elderly female patient with diabetic nephropathy presented with severe pain, numbness, and an increasing swelling in the left hip and left thigh after six sessions of hemodialysis involving the use of an antiplatelet drug and an anticoagulant agent. Her hemoglobin decreased to 46 g/L. An abdominal ultrasound showed a hematoma in the left retroperitoneal space, and computed tomography (CT) findings revealed a 6 cm × 8 cm × 10 cm hematoma...
Source: J Zhejiang Univ Sci ... - May 1, 2012 Category: Science Authors: Fan WX, Deng ZX, Liu F, Liu RB, He L, Amrit B, Zang L, Li JW, Liu XR, Huang SM, Fu P Tags: J Zhejiang Univ Sci B Source Type: research

Transpulmonary thermodilution measurements are not affected by continuous veno-venous hemofiltration at high blood pump flow
Conclusions CVVH with a high blood flow pump does not alter the transpulmonary thermodilution measurements of CI, GEDVI, and EVLWI. Content Type Journal ArticleCategory OriginalPages 1-7DOI 10.1007/s00134-012-2573-5Authors Nicolas Dufour, AP-HP, Hôpital de Bicêtre, service de réanimation médicale, 78, rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, FranceMarianne Delville, AP-HP, Hôpital de Bicêtre, service de réanimation médicale, 78, rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, FranceJean-Louis Teboul, AP-HP, Hôpital de Bicêtre, service de réanimation médicale, 78, rue du Gén...
Source: Intensive Care Medicine - April 28, 2012 Category: Intensive Care Tags: Intensive Care Medicine Source Type: research