Water treatment-free prolonged intermittent kidney replacement therapy: A new approach for kidney replacement therapy in the ICU setting. A retrospective study.

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care Pub Date : 2025-01-11 DOI:10.1016/j.jcrc.2025.155014

Noémie Zucman , Fabrice Uhel , Charles Verney , Jean-Damien Ricard , Didier Dreyfuss , Damien Roux

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引用次数: 0

Abstract

The optimal modalities of kidney replacement therapy (KRT) in the ICU remain debated. Intermittent haemodialysis (IHD) and continuous veno-venous haemofiltration (CVVH) are the two main methods. Intermittent haemodialysis requires a water treatment system, which may not be available in all jurisdictions. We report the experience of an innovative strategy of intermittent KRT without water treatment system.

Based on the manufacturer's recommendations, the dialysate flow during “CVVHDF post” (post-dilution continuous veno-venous haemodiafiltration) mode was increased by connecting the substitution pump in parallel with the dialysate pump using a Y-connector. This doubled the flow rate of dialysate, allowing for 9000 mL/h during intermittent KRT sessions at a blood flow rate of 250 mL/min. We called this technique “water treatment-free prolonged intermittent kidney replacement therapy” (WTF-PIKRT).

We report our experience in 18 patients who underwent 88 WTF-PIKRT sessions (median duration 5 h (IQR [4, 6])) between August 2019 and May 2020. The median urea reduction ratio was 38 % (IQR [29,49]). Hypotension occurred during 21.6 % of sessions. Hypokalemia or hypophosphatemia occurred in less than 5 % of sessions.

WTF-PIKRT represents an attractive alternative to conventional IHD when a water treatment system is not available. Despite its lower efficacy compared with IHD, it may have significant organizational and economic impact.

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无水治疗延长间歇肾替代治疗：在ICU环境下肾替代治疗的新途径。回顾性研究。

在ICU中肾脏替代治疗（KRT）的最佳方式仍然存在争议。间歇血液透析（IHD）和连续静脉-静脉血液滤过（CVVH）是两种主要的方法。间歇性血液透析需要水处理系统，这可能不是在所有司法管辖区都有。我们报告了无水处理系统的间歇式KRT创新策略的经验。根据制造商的建议，通过使用y型接头将替代泵与透析泵并联连接，增加了“CVVHDF后”（稀释后连续静脉-静脉血液滤过）模式下的透析液流量。这使透析液的流速增加了一倍，在血液流速为250 mL/min的间歇KRT期间，透析液的流速为9000 mL/h。我们称这种技术为“无水治疗延长间歇性肾脏替代疗法”（WTF-PIKRT）。我们报告了2019年8月至2020年5月期间接受88次WTF-PIKRT治疗（中位持续时间5小时（IQR[4,6]））的18例患者的经验。尿素还原率中位数为38% （IQR[29,49]）。21.6%的疗程出现低血压。低钾血症或低磷血症发生率低于5%。当没有水处理系统时，WTF-PIKRT是传统IHD的一个有吸引力的替代方案。尽管与IHD相比，它的疗效较低，但它可能具有显著的组织和经济影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of critical care 医学-危重病医学

CiteScore

8.60

自引率

2.70%

发文量

237

审稿时长

23 days

期刊介绍： The Journal of Critical Care, the official publication of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), is a leading international, peer-reviewed journal providing original research, review articles, tutorials, and invited articles for physicians and allied health professionals involved in treating the critically ill. The Journal aims to improve patient care by furthering understanding of health systems research and its integration into clinical practice. The Journal will include articles which discuss: All aspects of health services research in critical care System based practice in anesthesiology, perioperative and critical care medicine The interface between anesthesiology, critical care medicine and pain Integrating intraoperative management in preparation for postoperative critical care management and recovery Optimizing patient management, i.e., exploring the interface between evidence-based principles or clinical insight into management and care of complex patients The team approach in the OR and ICU System-based research Medical ethics Technology in medicine Seminars discussing current, state of the art, and sometimes controversial topics in anesthesiology, critical care medicine, and professional education Residency Education.