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How to Prolong Filter Life During Continuous Renal Replacement Therapy?

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Annual Update in Intensive Care and Emergency Medicine 2022

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM))

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Abstract

Acute kidney injury (AKI) is a major comorbidity in critically ill patients. Many interventions to prevent or treat AKI have been attempted but failed, so renal replacement therapy (RRT) remains the mainstay of essential intervention in critical care. Continuous RRT (CRRT) requires a measure to prevent the filter from clotting. The prevention of filter clotting is important because the downtime of the treatment can lead to undertreatment, potentially worsening clinical outcomes. Moreover, using extra filters increases healthcare costs. In this regard, pharmacological interventions and/or non-pharmacological interventions can be implemented. The most commonly applied and relatively well-investigated intervention is anticoagulation. The RICH trial published in 2020 provided up-to-date evidence of regional citrate anticoagulation. Where there is no contraindication, regional citrate anticoagulation is the first choice as a pharmacological strategy to keep the filter patent for CRRT. However, benefits from any pharmacological intervention compared to no pharmacological intervention are uncertain, particularly in patients at high risk of bleeding. For non-pharmacological interventions, convection predominant modes may shorten filter life; however, the evidence is uncertain. A systematic review and an observational study published in 2021 found most non-pharmacological interventions, e.g., keeping blood flow rates greater than 200 mL/min, prioritizing jugular access, do not have a solid basis to be recommended for routine practice. With widespread use of regional citrate anticoagulation over the last decade, high quality pragmatic trials investigating second line anticoagulation and non-pharmacological interventions in current ICU settings are warranted.

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Acknowledgments

This work was supported by Grant-in-Aid for Early-Career Scientists (JSPS KAKENHI 21K16580) to TF.

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Correspondence to T. Fujii .

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Tsujimoto, Y., Fujii, T. (2022). How to Prolong Filter Life During Continuous Renal Replacement Therapy?. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2022. Annual Update in Intensive Care and Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-93433-0_17

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  • DOI: https://doi.org/10.1007/978-3-030-93433-0_17

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