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Sohn JT. The elimination half-life of metformin during metformin overdose. Am J Emerg Med 2023; 70:183-184. [PMID: 37423821 DOI: 10.1016/j.ajem.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 07/01/2023] [Indexed: 07/11/2023] Open
Affiliation(s)
- Ju-Tae Sohn
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, 15 Jinju-daero 816 beon-gil, Jinju-si, Gyeongsangnam-do 52727, Republic of Korea; Institute of Medical Sciences, Gyeongsang National University, Jinju-si 52727, Republic of Korea.
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2
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Komaru Y, Oguchi M, Sadahiro T, Nakada TA, Hattori N, Moriguchi T, Goto J, Shiga H, Kikuchi Y, Negi S, Shigematsu T, Kuriyama N, Nakamura T, Doi K. Urinary neutrophil gelatinase-associated lipocalin and plasma IL-6 in discontinuation of continuous venovenous hemodiafiltration for severe acute kidney injury: a multicenter prospective observational study. Ann Intensive Care 2023; 13:42. [PMID: 37184598 DOI: 10.1186/s13613-023-01137-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 05/05/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Patients with severe acute kidney injury (AKI) who require continuous venovenous hemodiafiltration (CVVHDF) in intensive care unit (ICU) are at high mortality risk. Little is known about clinical biomarkers for risk prediction, optimal initiation, and optimal discontinuation of CVVHDF. METHODS This prospective observational study was conducted in seven university-affiliated ICUs. For urinary neutrophil gelatinase-associated lipocalin (NGAL) and plasma IL-6 measurements, samples were collected at initiation, 24 h, 48 h after, and CVVHDF discontinuation in adult patients with severe AKI. The outcomes were deaths during CVVHDF and CVVHDF dependence. RESULTS A total number of 133 patients were included. Twenty-eight patients died without CVVHDF discontinuation (CVVHDF nonsurvivors). Urinary NGAL and plasma IL-6 at the CVVHDF initiation were significantly higher in CVVHDF nonsurvivors than in survivors. Among 105 CVVHDF survivors, 70 patients were free from renal replacement therapy (RRT) or death in the next 7 days after discontinuation (success group), whereas 35 patients died or needed RRT again (failure group). Urinary NGAL at CVVHDF discontinuation was significantly lower in the success group (93.8 ng/ml vs. 999 ng/ml, p < 0.01), whereas no significant difference was observed in plasma IL-6 between the groups. Temporal elevations of urinary NGAL levels during the first 48 h since CVVHDF initiation were observed in CVVHDF nonsurvivors and those who failed in CVVHDF discontinuation. CONCLUSIONS Urinary NGAL at CVVHDF initiation and discontinuation was associated with mortality and RRT dependence, respectively. The serial changes of urinary NGAL might also help predict the prognosis of patients with AKI on CVVHDF.
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Affiliation(s)
- Yohei Komaru
- Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, Tokyo, Japan
| | - Moe Oguchi
- Department of Emergency and Critical Care Medicine, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
| | - Tomohito Sadahiro
- Department of Emergency and Critical Care Medicine, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
| | - Taka-Aki Nakada
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Noriyuki Hattori
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takeshi Moriguchi
- Department of Emergency and Critical Care Medicine, University of Yamanashi, Faculty of Medicine, Yamanashi, Japan
| | - Junko Goto
- Department of Emergency and Critical Care Medicine, University of Yamanashi, Faculty of Medicine, Yamanashi, Japan
| | - Hidetoshi Shiga
- Emergency and Intensive Care Center, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Yoshihiko Kikuchi
- Emergency and Intensive Care Center, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Shigeo Negi
- Department of Nephrology, Wakayama Medical University, Wakayama, Japan
| | | | - Naohide Kuriyama
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Aichi, Japan
| | - Tomoyuki Nakamura
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Aichi, Japan
| | - Kent Doi
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1138655, Japan.
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Eminoğlu FT, Öncül Ü, Kahveci F, Okulu E, Kraja E, Köse E, Kendirli T. Characteristics of continuous venovenous hemodiafiltration in the acute treatment of inherited metabolic disorders. Pediatr Nephrol 2022; 37:1387-1397. [PMID: 34693482 PMCID: PMC8542505 DOI: 10.1007/s00467-021-05329-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Continuous kidney replacement therapies (CKRT) have been reported to be an effective approach to removing toxic metabolites in inborn errors of metabolism (IEM). The present study evaluates efficiency and complications of CKRT in children with IEM. METHODS Patients diagnosed with IEM who underwent CKRT in pediatric and neonatal intensive care units were analyzed. CKRT were initiated in patients with persistently high blood ammonia levels (≥ 500 μmol/L), blood ammonia levels > 250 μmol/L in the presence of moderate encephalopathy, high blood leucine levels (≥ 1500 μmol/L), and blood leucine levels < 1500 μmol/L in the presence of deteriorating neurological status or persistent metabolic acidosis. RESULTS Of 22 patients enrolled, nine (40.9%) Maple syrup urine disease (MSUD), eight (36.4%) urea cycle disorders (UCD), and five (22.7%) organic acidemias (OA). Median age was 72.3 [9.9-1040.8] days. In total, 28 dialysis sessions were analyzed [16 (57.1%) continuous venovenous hemodialysis, and 12 (42.9%) continuous venovenous hemodiafiltration]. A significant decrease was noted in leucine levels (from 1608.4 ± 885.3 to 314.6 ± 109.9 µmol/L) of patients with MSUD, while ammonia levels were significantly decreased in patients with UCD and OA (from 1279.9 ± 612.1 to 85.1 ± 21.6 µmol/L). The most frequent complications of CKRT were thrombocytopenia (60.7%), hypotension (53.6%), and hypocalcemia (42.9%). Median age of patients with hypotension treated with vasoactive medications was significantly lower than median age of those with normal blood pressure. CONCLUSION CKRT is a reliable approach for effective and rapid removal of toxic metabolites in children with IEM, and CKRT modalities can be safely used and are well-tolerated in infants.
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Affiliation(s)
- Fatma Tuba Eminoğlu
- Department of Pediatric Metabolism, Faculty of Medicine, Ankara University, Ankara, Turkey.
| | - Ümmühan Öncül
- Department of Pediatric Metabolism, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Fevzi Kahveci
- Department of Pediatric Intensive Care Unit, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Emel Okulu
- Department of Neonatology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Elvis Kraja
- Department of Neonatology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Engin Köse
- Department of Pediatric Metabolism, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Tanıl Kendirli
- Department of Pediatric Intensive Care Unit, Faculty of Medicine, Ankara University, Ankara, Turkey
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4
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Kim DW, Kim HJ, Kim JM, Jeon YH, Han M, Seong EY, Song SH. Effect of Phoxilium on prognostic predictors in patients undergoing continuous venovenous hemodiafiltration. Kidney Res Clin Pract 2021; 40:457-471. [PMID: 34370933 PMCID: PMC8476306 DOI: 10.23876/j.krcp.20.217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 05/11/2021] [Indexed: 11/04/2022] Open
Abstract
Background Phosphorus-containing dialysis solution is used to prevent hypophosphatemia in patients undergoing continuous venovenous hemodiafiltration (CVVHDF). This study evaluated the effect of phosphorus-containing dialysis solution on mortality in patients undergoing CVVHDF based on changes in phosphorus and red cell distribution width-coefficient of variation (RDW-CV) levels. Methods We included 272 patients with acute kidney injury (AKI) who underwent CVVHDF at the medical intensive care unit from 2017 to 2019 and classified them according to Phoxilium (Baxter Healthcare Ltd.), as a phosphorus-containing dialysis solution, use within 48 hours after CVVHDF initiation. Clinical data were collected at baseline and 48 hours after CVVHDF initiation. The primary outcome was all-cause mortality during the follow-up period. Results The non-Phoxilium (NP) group had higher phosphorus and lower RDW-CV levels than the Phoxilium (P) group (phosphorus, 7.3 ± 4.3 vs. 5.0 ± 2.8 mg/dL; RDW-CV, 14.6 ± 1.9 vs. 15.7 ± 2.6%; all p < 0.001). In the multivariable Cox proportional hazard regression of the NP group, an increase in phosphorus and RDW-CV at 48 hours of CVVHDF was associated with mortality (delta phosphorus: median, >0 mg/dL vs. <-2.0 mg/dL; hazard ratio [HR], 8.62; 95% confidence interval [CI], 2.10-35.32; p = 0.003/delta RDW-CV: median, >0% vs. <-0.2%; HR, 4.34; 95% CI, 1.49-13.18; p = 0.008). Meanwhile, in the P group, an increase in delta RDW-CV was associated with mortality (delta RDW-CV: >0% vs. >-0.2% and <0%; HR, 2.65; 95% CI, 1.12-6.24; p = 0.03), while an increase in delta phosphorus was not. Conclusion In patients with AKI undergoing CVVHDF, the risk factors for all-cause mortality differed according to the initial phosphorus levels and use of Phoxilium.
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Affiliation(s)
- Da Woon Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Hyo Jin Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Jin Mi Kim
- Department of Biostatistics, Clinical Trial Center, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - You Hyun Jeon
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Miyeun Han
- Department of Internal Medicine, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| | - Eun Young Seong
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Sang Heon Song
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
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Silva DT, Dantas C, Santos AS, Silva C, Aires I, Remédio F, Carrelhas S, Pena A, Reis JE, Calvinho P, Semedo L, Cardoso J, Nolasco F, Fragata J. Combined lung-kidney transplantation: First case in Portugal. Respir Med Case Rep 2021; 33:101386. [PMID: 34401253 PMCID: PMC8348689 DOI: 10.1016/j.rmcr.2021.101386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/02/2021] [Accepted: 03/12/2021] [Indexed: 11/16/2022] Open
Abstract
A significant dysfunction of another organ is usually considered an absolute contraindication for lung transplantation, unless multiorgan transplantation is indicated and practical, as is the case of combined lung-kidney transplantation. Few cases of combined lung-kidney transplantation have been described in the literature; however, it is known that, in certain cases, it is the only way to offer an opportunity to selected patients with renal and lung dysfunction. The authors are not aware of any previously published case of a patient receiving both extracorporeal membrane oxygenation and continuous venovenous hemodiafiltration as a bridge for combined kidney-lung transplantation. The authors present the first case of combined lung-kidney transplantation performed in Portugal.
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Affiliation(s)
- David T Silva
- Pulmonology Department, Hospital of Santa Marta, Centro Hospitalar Universitário Lisboa Central (CHULC), Portugal.,NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal
| | - Carolina Dantas
- Pulmonology Department, Hospital of Santa Marta, Centro Hospitalar Universitário Lisboa Central (CHULC), Portugal.,NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal
| | - Ana Sofia Santos
- Pulmonology Department, Hospital of Santa Marta, Centro Hospitalar Universitário Lisboa Central (CHULC), Portugal.,NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal
| | - Cecilia Silva
- Nephrology Department, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Portugal.,NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal
| | - Inês Aires
- Nephrology Department, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Portugal.,NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal
| | - Francisco Remédio
- Nephrology Department, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Portugal.,NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal
| | - Sofia Carrelhas
- General Surgery Department, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Portugal.,NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal
| | - Ana Pena
- General Surgery Department, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Portugal.,NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal
| | - João Eurico Reis
- Cardiothoracic Department, Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central (CHULC), Portugal.,NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal
| | - Paulo Calvinho
- Cardiothoracic Department, Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central (CHULC), Portugal.,NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal
| | - Luísa Semedo
- Pulmonology Department, Hospital of Santa Marta, Centro Hospitalar Universitário Lisboa Central (CHULC), Portugal.,NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal
| | - João Cardoso
- Pulmonology Department, Hospital of Santa Marta, Centro Hospitalar Universitário Lisboa Central (CHULC), Portugal.,NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal
| | - Fernando Nolasco
- Nephrology Department, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Portugal.,NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal
| | - José Fragata
- Cardiothoracic Department, Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central (CHULC), Portugal.,NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal
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Oda K, Jono H, Sagishima K, Saito H. Augmented teicoplanin clearance through probable adsorption onto a polymethyl methacrylate (PMMA) hemofilter during continuous venovenous hemodiafiltration. J Infect Chemother 2020; 26:992-994. [PMID: 32334950 DOI: 10.1016/j.jiac.2020.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/04/2020] [Accepted: 04/01/2020] [Indexed: 12/01/2022]
Abstract
Teicoplanin, a glycopeptide antibiotic against Gram-positive bacteria, is used during continuous venovenous hemodiafiltration (CVVHDF), though adsorption onto a hemofilter has been observed in an in-vitro study. We report a case of extensive augmentation of teicoplanin clearance by a polymethyl methacrylate (PMMA) hemofilter. A 74-year-old man (body weight 53 kg) was performed CVVHDF with the PMMA hemofilter. The effluent flow rate maintained at 600-650 mL/h. The measured teicoplanin clearance was 31.0 mL/min, and the clearance was reduced to 11.1 mL/min over the next 6.5 hours. In conclusion, we should closely monitor teicoplanin dosing during CVVHDF using a PMMA membrane hemofilter.
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Affiliation(s)
- Kazutaka Oda
- Department of Pharmacy, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan.
| | - Hirofumi Jono
- Department of Pharmacy, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan.
| | - Katsuyuki Sagishima
- Department of Critical Care Medicine, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan.
| | - Hideyuki Saito
- Department of Pharmacy, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan.
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Kaçar CK, Uzundere O, Kandemir D, Yektaş A. Efficacy of HA330 Hemoperfusion Adsorbent in Patients Followed in the Intensive Care Unit for Septic Shock and Acute Kidney Injury and Treated with Continuous Venovenous Hemodiafiltration as Renal Replacement Therapy. Blood Purif 2020; 49:448-456. [PMID: 31991412 DOI: 10.1159/000505565] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 12/19/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Blood purification is an option for treatment of the source of sepsis when correcting patients' septic shock-induced clinical status. We investigated the efficacy of HA330 hemoperfusion adsorbent application with renal replacement therapy in patients with septic shock and acute kidney injury. METHODS This prospective observational study involved 23 patients diagnosed with sepsis who underwent continuous venovenous hemodiafiltration and HA330 hemoperfusion for 2 h once daily for 3 days. The patients' demographic data, comorbidities, lengths of intensive care unit and hospital stays, blood cell counts, blood biochemistry values, coagulation values, blood gas values, inflammatory markers, hemodynamic parameters, and inotropic medication use before and after each application of HA330 hemoperfusion were recorded. The effectiveness of HA330 hemoperfusion was evaluated by comparing the parameters on days 0 and 1, 1 and 2, and 2 and 3. RESULTS The pH increased significantly following the first application of HA330 hemoperfusion (p = 0.001), the C-reactive protein (CRP) and procalcitonin levels decreased significantly after the second application (p = 0.002 and 0.018, respectively), and the CRP level decreased significantly following the third application (p = 0.046). CONCLUSIONS The application of HA330 hemoperfusion 2 h daily for 3 consecutive days improved level of CRP and heart rate, but had no effect on others or on the prognosis.
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Affiliation(s)
- Cem Kıvılcım Kaçar
- Health Sciences University Diyarbakır Gazi Yaşargil Education and Research Hospital Anesthesia and Reanimation Clinic, Diyarbakır, Turkey
| | - Osman Uzundere
- Health Sciences University Diyarbakır Gazi Yaşargil Education and Research Hospital Anesthesia and Reanimation Clinic, Diyarbakır, Turkey
| | - Deniz Kandemir
- Health Sciences University Diyarbakır Gazi Yaşargil Education and Research Hospital Anesthesia and Reanimation Clinic, Diyarbakır, Turkey
| | - Abdulkadir Yektaş
- Health Sciences University Diyarbakır Gazi Yaşargil Education and Research Hospital Anesthesia and Reanimation Clinic, Diyarbakır, Turkey,
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Celik M, Akdeniz O, Ozgun N, Ipek MS, Ozbek MN. Short-term results of continuous venovenous haemodiafiltration versus peritoneal dialysis in 40 neonates with inborn errors of metabolism. Eur J Pediatr 2019; 178:829-836. [PMID: 30895385 DOI: 10.1007/s00431-019-03361-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/23/2019] [Accepted: 03/04/2019] [Indexed: 12/31/2022]
Abstract
Several recent studies have reported that toxic metabolites accumulated in the body as a product of inborn errors of metabolism (IEM) are eliminated more rapidly with continuous venovenous hemodiafiltration (CVVHDF) than with peritoneal dialysis (PD). However, there is still uncertainty about the impacts of dialysis modalities on the short-term outcome. Here, it was aimed to investigate the effects of dialysis modalities on the short-term outcome. This retrospective study included 40 newborn infants who underwent PD (29 patients) or CVVHDF (11 patients) due to inborn errors of metabolism at a tertiary centre, between June 2013 and March 2018. The outcomes and the potential effects of the dialysis modality were evaluated. Of 40 patients, 21 were urea cycle defect, 14 were organic academia, and 5 were maple syrup urine disease. The median 50% reduction time of toxic metabolites were shorter in patients treated with CVVHDF (p < 0.05). Catheter blockage was the most common complication observed in PD group (24.1%), whereas in CVVHDF group hypotension and filter blockage were more common. There was no significant difference in mortality between dialysis groups (38% vs. 45.4%, p > 0.05). In patients with hyperammonaemia, duration of plasma ammonia > 200 μg/dL was the most important factor influencing mortality (OR 1.05, CI 1.01-1.09, p = 0.007).Conclusion: This study showed that CVVHDF is more efficient than PD to rapidly eliminate toxic metabolites caused by IEM in newborn infants, but not in improving survival. What is Known: •Toxic metabolites are eliminated more rapidly with CVVHDF than with PD. •Higher complication rates were reported with rigid peritoneal catheters in PD and catheter blockage in CVVHDF. What is New: •Prolonged duration of plasma ammonia levels above a safe limit (200 μg/dL) was associated with increased mortality. •Lower catheter-related complication rates may have been associated with the use of Tenckhoff catheters in PD and the use of right internal jugular vein in CVVHDF.
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Affiliation(s)
- Muhittin Celik
- Department of Pediatrics, Division of Neonatology, Gaziantep University, Osmangazi Mahallesi, Üniversite Blv., 27310 Şehitkamil, Gaziantep, Turkey.
| | - Osman Akdeniz
- Department of Pediatrics, Division of Pediatric Cardiology, Diyarbakir Children's Diseases Hospital, Diyarbakir, Turkey
| | - Nezir Ozgun
- Department of Pediatrics, Division of Pediatric Neurology, Diyarbakir Children's Diseases Hospital, Diyarbakir, Turkey
| | - Mehmet Sah Ipek
- Department of Pediatrics, Division of Neonatology, Memorial Dicle Hospital, Diyarbakir, Turkey
| | - Mehmet Nuri Ozbek
- Department of Pediatrics, Division of Pediatric Endocrinology and Metabolism, Gazi Yaşargil Training and Research Hospital, Diyarbakir, Turkey
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Liu S, Xu L, Ma J, Huang R, Lin T, Li Z, Liang H, Li S, Li R, Zhang L, Tao Y, Li Z, Chen Y, Ye Z, Zhang B, Wang W, Xiao H, Liang X, Shi W. High-volume continuous venovenous hemodiafiltration plus resin hemoperfusion improves severe metformin-associated toxicity. J Diabetes Investig 2018; 9:975-978. [PMID: 28980449 PMCID: PMC6031495 DOI: 10.1111/jdi.12757] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/18/2017] [Accepted: 09/25/2017] [Indexed: 12/19/2022] Open
Abstract
We present the case of a 42-year-old female patient who attempted suicide by taking approximately 100 tablets of metformin (500 mg). Laboratory tests revealed severe lactic acidosis with lactate levels of 24 mmol/L and pH of 7.09. The patient was treated with high-volume continuous venovenous hemodiafiltration (CVVH) and resin-sorbent hemoperfusion. Metformin concentrations were measured by high-performance liquid chromatography during CVVH and hemoperfusion treatment. Before extracorporeal treatment, the plasma metformin concentration was 208.5 mg/L. After CVVH treatment for 24 h, the plasma metformin concentration had decreased to 13.9 mg/L. Resin-based sorbent hemoperfusion plus CVVH treatment had reduced the metformin plasma concentration by 61.8% after 3 h. After 7 days, the patient's laboratory tests and clinical syndrome were improved, and she was discharged from hospital. We provide evidence that CVVH plus hemoperfusion is effective in eliminating metformins and metabolic products.
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Affiliation(s)
- Shuangxin Liu
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Lixia Xu
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Jianchao Ma
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Renwei Huang
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Ting Lin
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Zhuo Li
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Huabang Liang
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Sijia Li
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Ruizhao Li
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Li Zhang
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Yiming Tao
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Zhilian Li
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Yuanhan Chen
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Zhiming Ye
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Bin Zhang
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Wenjian Wang
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Houqing Xiao
- Dongguan City Five People's HospitalDongguanGuangdongChina
| | - Xinling Liang
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Wei Shi
- Department of NephrologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongChina
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Al-Hwiesh A, Abdul-Rahman I, Finkelstein F, Divino-Filho J, Qutub H, Al-Audah N, Abdelrahman A, El-Fakhrany N, Nasr El-Din M, El-Salamony T, Noor A, Al-Shahrani M, Al-Otaibi K. Acute Kidney Injury in Critically Ill Patients: A Prospective Randomized Study of Tidal Peritoneal Dialysis Versus Continuous Renal Replacement Therapy. Ther Apher Dial 2018; 22:371-379. [PMID: 29575788 DOI: 10.1111/1744-9987.12660] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 09/23/2017] [Accepted: 11/14/2017] [Indexed: 11/28/2022]
Abstract
Few studies have discussed the role of peritoneal dialysis (PD) in managing acute kidney injury (AKI) in critically ill patients. The present study compares the outcome of AKI in intensive care unit (ICU) patients randomized to treatment with tidal PD (TPD) or continuous venovenous hemodiafiltration (CVVHDF). One hundred and twenty-five ICU patients with AKI were randomly allotted to CVVHDF, (Group A, N = 62) or TPD, (group B, N = 63). Cause and severity of renal injury were assessed at the time of initiating dialysis. The primary outcome was hospital mortality at 28 days, and secondary outcomes were time to recovery of renal function, duration of stay in the ICU, metabolic and fluid control, and improvement of sensorial and hemodynamic parameters. No statistically significant differences were observed between groups in regard to patients' characteristics. The survival at 28 days was significantly better in the patients treated with TPD when compared to CVVHDF (69.8% vs. 46.8%, P < 0.01). Infectious complications were significantly less (P < 0.01) in the TPD group (9.5%) when compared to the CVVHDF group (17.7%). Recovery of kidney function (60.3% vs. 35.5%), median time to resolution of AKI and the median duration of ICU stay of 9 days (7-11) vs. 19 days (13-20) were all in favor of TPD (P < 0.01). This study suggests that there are better outcomes with TPD compared to CRRT in the treatment of critically ill patients with AKI.
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Affiliation(s)
- Abdullah Al-Hwiesh
- Nephrology Division, King Fahd Hospital of the University, Al-Khobar, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Ibrahiem Abdul-Rahman
- Nephrology Division, King Fahd Hospital of the University, Al-Khobar, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | | | - Jose Divino-Filho
- Karolinska Institutet, CLINTEC, Division of Renal Medicine, Stockholm, Sweden
| | - Hatem Qutub
- Nephrology Division, King Fahd Hospital of the University, Al-Khobar, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Nadia Al-Audah
- Nephrology Division, King Fahd Hospital of the University, Al-Khobar, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Abdalla Abdelrahman
- Department of Electrical Engineering, Queens University, Kingston, ON, Canada
| | - Nazeeh El-Fakhrany
- Nephrology Division, King Fahd Hospital of the University, Al-Khobar, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Mohammed Nasr El-Din
- Nephrology Division, King Fahd Hospital of the University, Al-Khobar, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Tamer El-Salamony
- Nephrology Division, King Fahd Hospital of the University, Al-Khobar, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Abdulsalam Noor
- Nephrology Division, King Fahd Hospital of the University, Al-Khobar, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Mohammed Al-Shahrani
- Nephrology Division, King Fahd Hospital of the University, Al-Khobar, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Khalid Al-Otaibi
- Nephrology Division, King Fahd Hospital of the University, Al-Khobar, Imam Abdulrahman Bin Faisal University, Saudi Arabia
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Yetimakman AF, Tanyildiz M, Kesici S, Kockuzu E, Bayrakci B. Continuous Renal Replacement Therapy Applications on Extracorporeal Membrane Oxygenation Circuit. Indian J Crit Care Med 2017; 21:355-358. [PMID: 28701841 PMCID: PMC5492737 DOI: 10.4103/ijccm.ijccm_128_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND AIMS Continuous venovenous hemofiltration or hemodiafiltration is used frequently in pediatric patients, but experience of continuous renal replacement therapy (CRRT) application on extracorporeal membrane oxygenation (ECMO) circuit is still limited. Among several methods used for applying CRRT on ECMO patients, we aim to share our experience on inclusion of a CRRT device in the ECMO circuit which we believe is easier and safer to apply. MATERIALS AND METHODS The data were collected on demographics, outcomes, and details of the treatment of ECMO patients who had CRRT. During the study period of 3 years, venous cannula of ECMO circuit before pump was used for CRRT access for both the filter inlet and outlet of CRRT machine to minimize the thromboembolic complications. The common indication for CRRT was fluid overload. RESULTS CRRT was used in 3.68% of a total number of patients admitted and 43% of patients on ECMO. The patients have undergone renal replacement therapy for periods of time ranging between 24 h and 25 days (260 h mean). The survival rate of this group of patients with multiorgan failure was 33%. Renal recovery occurred in all of the survivors. Complications such as electrolyte imbalance, hypothermia, and bradykinin syndrome were easily managed. CONCLUSIONS Adding a CRRT device on ECMO circuit is a safe and effective technique. The major advantages of this technique are easy to access, applying CRRT without extra anticoagulation process, preventing potential hemodynamic disturbances, and increased clearance of solutes and fluid overload using larger hemofilter.
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Affiliation(s)
- Ayse Filiz Yetimakman
- Department of Pediatric Intensive Care Medicine, Hacettepe University, Ankara, Turkey
| | - Murat Tanyildiz
- Department of Pediatric Intensive Care Medicine, Hacettepe University, Ankara, Turkey
| | - Selman Kesici
- Department of Pediatric Intensive Care Medicine, Dr. Sami Ulus Maternity and Children's Training and Research Hospital, Ankara, Turkey
| | - Esra Kockuzu
- Department of Pediatric Intensive Care Medicine, Hacettepe University, Ankara, Turkey
| | - Benan Bayrakci
- Center for Life Support Clinics and Research, Hacettepe University, Ankara, Turkey
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Tal L, Angelo JR, Akcan-Arikan A. Neonatal extracorporeal renal replacement therapy-a routine renal support modality? Pediatr Nephrol 2016; 31:2013-5. [PMID: 27270721 DOI: 10.1007/s00467-016-3423-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 05/13/2016] [Indexed: 11/28/2022]
Abstract
Peritoneal dialysis (PD) is generally considered the preferred extracorporeal therapy for neonates with acute kidney injury (AKI). However, there are situations when PD is not suitable, such as in patients with previous abdominal surgery, hyperammonemia and significant ascites or anasarca. Additionally, with a need to start PD soon after catheter placement, there is increased risk of PD catheter leak and infection. Extracorporeal continuous renal replacement therapy (CRRT) is challenging in severely ill neonates as it requires obtaining adequately sized central venous access to accommodate adequate blood flow rates and also adaptation of a CRRT machine meant for older children and adults. In addition, ultrafiltration often cannot be set in sufficiently small increments to be suitable for neonates. Although CRRT practices can be modified to fit the needs of infants and neonates, there is a need for a device designed specifically for this population. Until that becomes available, providing the highest level of care for neonates with AKI is dependent on the shared experiences of members of the pediatric nephrology community.
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Affiliation(s)
- Leyat Tal
- Renal Section, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Joseph R Angelo
- Renal Section, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Ayse Akcan-Arikan
- Renal Section, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA. .,Section of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, 6621 Fannin Street, Houston, TX, 77030, USA.
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Hajjej Z, Gharsallah H, Naija H, Boutiba I, Labbene I, Ferjani M. Successful treatment of a Carbapenem-resistant Klebsiella pneumoniae carrying bla OXA-48 , bla VIM-2 , bla CMY-2 and bla SHV- with high dose combination of imipenem and amikacin. IDCases 2016; 4:10-2. [PMID: 27051575 PMCID: PMC4802673 DOI: 10.1016/j.idcr.2016.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 01/10/2016] [Indexed: 12/02/2022] Open
Abstract
We describe a case of 58-year-old man with septic shock due to Carbapenem-resistant Klebsiella pneumoniae (CR-Kp) bloodstream infections (BSI) who was successfully treated with a high dose association of amikacin and imipenem combined with continuous venovenous hemodiafiltration (CVVHDF). A Klebsiella pneumoniae (Kp) was isolated from the catheter culture and from two blood samples, drawn from the catheter before removal and from a peripheral vein. The Kp was intermediate to Amikacin (MIC = 16 μg/ml) and was resistant to all other antibiotics including Imipenem (MIC = 4 μg/ml), Colistin (MIC = 16 μg/ml) and Tigecycline (MIC = 4 μg/ml) according to the Clinical and Laboratory Standards Institute (CLSI) published in 2011. PCR amplification and sequencing verified the presence of blaOXA-48, blaVIM-2, blaCMY-2 and blaSHV-1 genes. Amikacin was given at a dose of 30 mg/kg (2.5 g) in a 30 min infusion and the dose of imipenem was increased to 1 g every 6 h despite patient's altered renal function (Creatinine Clearance = 25 ml/min). To avoid amikacin nephrotoxicity and to allow the use of high doses of imipenem, continuous venovenous hemodiafiltration (CVVHDF) (blood flow, 200 ml/h; dialysate, 1000 ml/h; ultrafiltrate, 2000 ml/h) was initiated 1 h after the start of the amikacin infusion and continued thereafter. The patient improved hemodynamically and norepinephrine was stopped five days after antibiotherapy adaptation.
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Affiliation(s)
- Zied Hajjej
- Intensive Care Unit, Military Hospital of Tunis, Montfleury, 1008 Tunis, Tunisia
| | | | | | - Ilhem Boutiba
- Laboratory of Research "resistance to antibiotics" Faculty of Medicine of Tunis, Tunisia
| | - Iheb Labbene
- Intensive Care Unit, Military Hospital of Tunis, Tunisia
| | - Mustapha Ferjani
- Head of Department of Intensive Care Unit, Military Hospital of Tunis, Tunisia
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