Continuous Renal Replacement Therapy (CRRT)

This chapter will summarize current knowledge in renal replacement technologies in the treatment of critically ill patients with acute kidney injury. The mechanics of different treatment modalities with emphasis on continuous renal replacement therapies will be described, as well as the application of such technologies in the management of fluid overload and metabolic abnormalities. Appropriate composition of dialysate and replacement fluids, use of anticoagulation, choice of vascular access, and potential complications in the use of such technologies will be discussed. Finally, the chapter will compare the main features of the different currently available CRRT machines.

[1]  B. Jaber,et al.  Factors associated with urea reduction ratio in acute renal failure. , 2004, Artificial organs.

[2]  M. Drent,et al.  Too few, too late: submission patterns of bronchoalveolar lavage fluid samples obtained under the suspicion of the diagnosis of ventilator-associated pneumonia , 2006, Critical Care.

[3]  P. Murray,et al.  Argatroban and Renal Replacement Therapy in Patients with Heparin-Induced Thrombocytopenia , 2005, The Annals of pharmacotherapy.

[4]  J. van Limbeek,et al.  Low polymorphonuclear cell degranulation during citrate anticoagulation: a comparison between citrate and heparin dialysis. , 1997, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[5]  G. Colussi,et al.  Quantitative analysis of convective dose in hemofiltration and hemodiafiltration: “Predilution” vs. “postdilution” reinfusion , 2007, Hemodialysis international. International Symposium on Home Hemodialysis.

[6]  R. Bellomo,et al.  Critical care nephrology: the time has come. , 1998, Kidney international. Supplement.

[7]  P. Leitienne,et al.  Complement C3 and C5 Degradation Products during Hemodialysis Treatment: Study of an Index of Membrane Bioincompatibility , 1988, The International journal of artificial organs.

[8]  R. Gillespie,et al.  Effect of fluid overload and dose of replacement fluid on survival in hemofiltration , 2004, Pediatric Nephrology.

[9]  S. Morgera,et al.  Metabolic Complications during Regional Citrate Anticoagulation in Continuous Venovenous Hemodialysis: Single-Center Experience , 2004, Nephron Clinical Practice.

[10]  J. Fortenberry,et al.  Fluid overload before continuous hemofiltration and survival in critically ill children: A retrospective analysis* , 2004, Critical care medicine.

[11]  M. Zimpfer,et al.  Anticoagulation with prostaglandins and unfractionated heparin during continuous venovenous haemofiltration: a randomized controlled trial. , 2002, Wiener klinische Wochenschrift.

[12]  L. Rostaing,et al.  Regional citrate anticoagulation in continuous venovenous haemodiafiltration using commercial solutions. , 2004, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[13]  W. Clark,et al.  Kinetic comparison of different acute dialysis therapies. , 2003, Artificial organs.

[14]  R. Bellomo,et al.  The future of extracorporeal support , 2008, Critical care medicine.

[15]  M. Leblanc,et al.  Phosphate addition to hemodiafiltration solutions during continuous renal replacement therapy , 2004, Intensive Care Medicine.

[16]  L. Agodoa,et al.  Total hip arthroplasty in chronic dialysis patients in the United States. , 2003, Journal of nephrology.

[17]  R. Bellomo,et al.  High volume hemofiltration in critically ill patients: why, when and how? , 2004, Contributions to nephrology.

[18]  P. Audia,et al.  UNRESOLVED ISSUES IN DIALYSIS: Extracorporeal Strategies for the Removal of Middle Molecules , 2006 .

[19]  A. Davenport,et al.  Effects of lactate-buffered and lactate-free dialysate in CAVHD patients with and without liver dysfunction. , 2000, Kidney international.

[20]  M. Oliver,et al.  A novel regional citrate anticoagulation protocol for CRRT using only commercially available solutions. , 2003, Journal of critical care.

[21]  Rinaldo Bellomo,et al.  Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial , 2000, The Lancet.

[22]  S. Lasocki,et al.  Anti-PF4/heparin antibodies associated with repeated hemofiltration-filter clotting: a retrospective study , 2008, Critical care.

[23]  R. Bellomo,et al.  Continuous renal replacement therapy: A worldwide practice survey , 2007, Intensive Care Medicine.

[24]  H. Burchardi History and development of continuous renal replacement techniques. , 1998, Kidney international. Supplement.

[25]  Didier Payen,et al.  A positive fluid balance is associated with a worse outcome in patients with acute renal failure , 2008, Critical care.

[26]  M. Rudnick,et al.  The case for primary placement of tunneled hemodialysis catheters in acute kidney injury. , 2009, Journal of Vascular and Interventional Radiology.

[27]  D. Hommes,et al.  Monitoring Anticoagulant Therapy by Activated Partial Thromboplastin Time: Hirudin Assessment , 1994, Thrombosis and Haemostasis.

[28]  Didier Journois,et al.  [Field 7. Safety practice for renal-replacement therapies. French-speaking Society of Intensive Care. French Society of Anesthesia and Resuscitation]. , 2008, Annales francaises d'anesthesie et de reanimation.

[29]  D. Matamis,et al.  Influence of continuous haemofiltration-related hypothermia on haemodynamic variables and gas exchange in septic patients , 1994, Intensive Care Medicine.

[30]  J. Walshe,et al.  Access recirculation in temporary hemodialysis catheters as measured by the saline dilution technique. , 2000, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[31]  C. Ronco,et al.  THE CLINICAL APPLICATION OF CRRT—CURRENT STATUS: Modalities of Continuous Renal Replacement Therapy: Technical and Clinical Considerations , 2009, Seminars in dialysis.

[32]  R. Vanholder,et al.  The middle-molecule hypothesis 30 years after: lost and rediscovered in the universe of uremic toxicity? , 2008, Journal of nephrology.

[33]  T. Saruta,et al.  Agranulocytosis in a haemodialysed patient induced by a proteinase inhibitor, nafamostate mesilate. , 1992, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[34]  S. Zanotti-Cavazzoni Early Use of Polymyxin B Hemoperfusion in Abdominal Septic Shock: The EUPHAS Randomized Controlled Trial , 2010 .

[35]  R. Bellomo,et al.  How to feed patients with renal dysfunction. , 2000, Current opinion in critical care.

[36]  C. Ronco,et al.  Intermittent Hirudin Versus Continuous Heparin for Anticoagulation in Continuous Renal Replacement Therapy , 2004, Renal failure.

[37]  B. Fornage,et al.  Complications and failures of subclavian-vein catheterization. , 1994, The New England journal of medicine.

[38]  H. Meier‐Kriesche,et al.  Increased total to ionized calcium ratio during continuous venovenous hemodialysis with regional citrate anticoagulation , 2001, Critical care medicine.

[39]  Elena Mancini,et al.  Thermal balance in convective therapies. , 2003, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[40]  S. Swan,et al.  A prospective comparison of three argatroban treatment regimens during hemodialysis in end-stage renal disease. , 2004, Kidney international.

[41]  C. Leue,et al.  Lactate- or bicarbonate-buffered solutions in continuous extracorporeal renal replacement therapies. , 1999, Kidney international. Supplement.

[42]  A. Bihorac,et al.  Continuous venovenous hemofiltration with citrate-based replacement fluid: efficacy, safety, and impact on nutrition. , 2005, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[43]  J. Winchester,et al.  Beta-2 microglobulin in ESRD: an in-depth review. , 2003, Advances in renal replacement therapy.

[44]  C. Ronco,et al.  Pulse High‐Volume Hemofiltration in Critically Ill Patients: A New Approach for Patients with Septic Shock , 2006, Seminars in dialysis.

[45]  K. Finkel,et al.  THE CLINICAL APPLICATION OF CRRT—CURRENT STATUS: Complications of Continuous Renal Replacement Therapy , 2009, Seminars in dialysis.

[46]  Central vein catheterization. Failure and complication rates by three percutaneous approaches. , 1986, Archives of internal medicine.

[47]  M. Byrne,et al.  Citrate Vs. Heparin For Anticoagulation In Continuous Venovenous Hemofiltration: A Prospective Randomized Study. , 2004 .

[48]  J. Santamaria,et al.  A controlled trial of low-molecular-weight heparin (dalteparin) versus unfractionated heparin as anticoagulant during continuous venovenous hemodialysis with filtration. , 1999, Critical care medicine.

[49]  W. Silvester,et al.  Mediator removal with CRRT: complement and cytokines. , 1997, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[50]  A. Kaplan,et al.  Regional heparinization for continuous arterio-venous hemofiltration (CAVH). , 1987, ASAIO transactions.

[51]  T. Ortel,et al.  Heparin-induced thrombocytopenia. , 2006, Seminars in hematology.

[52]  S. Mataloun,et al.  Guillan–Barré syndrome affects the quality of life after discharge from the ICU , 2009, Critical Care.

[53]  M. Jadoul,et al.  Diagnosis, prevention and treatment of haemodialysis catheter-related bloodstream infections (CRBSI): a position statement of European Renal Best Practice (ERBP) , 2010, NDT plus.

[54]  Sudhir V. Shah,et al.  Development of a clinical research agenda for acute kidney injury using an international, interdisciplinary, three-step modified Delphi process. , 2008, Clinical journal of the American Society of Nephrology : CJASN.

[55]  Ingrid Ledebo,et al.  Convective Dialysis Therapies, Current Status and Perspective , 2005, Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy.

[56]  S. Brunet,et al.  Diffusive and convective solute clearances during continuous renal replacement therapy at various dialysate and ultrafiltration flow rates. , 1999, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[57]  A. Davenport,et al.  Comparison of the use of standard heparin and prostacyclin anticoagulation in spontaneous and pump-driven extracorporeal circuits in patients with combined acute renal and hepatic failure. , 1994, Nephron.

[58]  P. Fall,et al.  Continuous Renal Replacement Therapy: Cause and Treatment of Electrolyte Complications , 2010, Seminars in dialysis.

[59]  S. Bagshaw,et al.  Is regional citrate superior to systemic heparin anticoagulation for continuous renal replacement therapy? A prospective observational study in an adult regional critical care system. , 2005, Journal of critical care.

[60]  Eric De Groot,et al.  Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients , 2006, Critical care.

[61]  J. Fortenberry,et al.  Multi-centre evaluation of anticoagulation in patients receiving continuous renal replacement therapy (CRRT). , 2005, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[62]  Salim Lim Continuous renal replacement therapy in intensive care unit , 2005 .

[63]  C. Ronco Recent evolution of renal replacement therapy in the critically ill patient , 2006, Critical care.

[64]  D. Journois,et al.  Comparaison des effets antithrombotiques de l'héparine, l'énoxaparine et la prostacycline au cours de l'hémofiltration continue , 1990 .

[65]  H. Nakae,et al.  Pharmacokinetics of Nafamostat Mesilate During Continuous Hemodiafiltration with a Polyacrylonitrile Membrane , 2003, Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy.

[66]  K. Ivens,et al.  Acid-base balance and substitution fluid during continuous hemofiltration. , 1999, Kidney international. Supplement.

[67]  J. Małyszko,et al.  Femoral Localization and Higher Ultrafiltration Rate but Not Concentration of Heparin Used for Canal Locking of Hemodialysis Catheter Are Negative Predictors for Its Malfunction , 2007, American Journal of Nephrology.

[68]  W. Druml [Anticoagulation in continuous renal replacement procedures]. , 2002, Wiener klinische Wochenschrift.

[69]  A. Davenport,et al.  Improved cardiovascular stability during continuous modes of renal replacement therapy in critically ill patients with acute hepatic and renal failure , 1993, Critical care medicine.

[70]  Rainald Fischer,et al.  Daily hemodialysis and the outcome of acute renal failure. , 2002, The New England journal of medicine.

[71]  A. Kaye,et al.  Effect of anticoagulation on blood membrane interactions during hemodialysis. , 1999, Kidney international.

[72]  L. Weisberg Catheter dysfunction and dialysis performance according to vascular access among 736 critically ill adults requiring renal replacement therapy: A randomized controlled study , 2011 .

[73]  M. Zimpfer,et al.  Anticoagulation with prostaglandin E1 and unfractionated heparin during continuous venovenous hemofiltration. , 1998, Critical care medicine.

[74]  P. Peduzzi,et al.  Intensity of renal support in critically ill patients with acute kidney injury. , 2008, The New England journal of medicine.

[75]  R. Bellomo,et al.  Anticoagulant regimens in acute continuous hemodiafiltration: a comparative study , 2005, Intensive Care Medicine.

[76]  R. Swartz,et al.  Improving the delivery of continuous renal replacement therapy using regional citrate anticoagulation. , 2004, Clinical nephrology.

[77]  M. Zimpfer,et al.  Anticoagulation with prostacyclin and heparin during continuous venovenous hemofiltration , 1994, Critical care medicine.

[78]  R. Sachdeva,et al.  Outcome in children receiving continuous venovenous hemofiltration. , 2001, Pediatrics.

[79]  J. Chevrolet,et al.  Anticoagulation in patients treated by continuous venovenous hemofiltration: a retrospective study. , 1994, American Journal of Kidney Diseases.

[80]  R. Bellomo,et al.  Commercial Low-citrate Anticoagulation Haemofiltration in High Risk Patients with Frequent Filter Clotting , 2005, Anaesthesia and intensive care.

[81]  R. Bellomo,et al.  Continuous renal replacement techniques. , 2001, Contributions to nephrology.

[82]  Martina niChonghaile Complications of Femoral and Subclavian Venous Catheterization in Critically Ill Patients: A Randomized Controlled Trial , 2002 .

[83]  J. Helterbrand,et al.  Efficacy and safety of recombinant human activated protein C for severe sepsis , 2003 .

[84]  J. Tattersall,et al.  Clearance of beta-2-microglobulin and middle molecules in haemodiafiltration. , 2007, Contributions to nephrology.

[85]  M. Tal,et al.  Selecting optimal hemodialysis catheters: material, design, advanced features, and preferences. , 2008, Techniques in vascular and interventional radiology.

[86]  S. Ash,et al.  Classification of Complications Associated with Hemodialysis Vascular Access Procedures: A Position Statement from the American Society of Diagnostic and Interventional Nephrology , 2007 .

[87]  S. Bagshaw,et al.  Fluid balance as a biomarker: impact of fluid overload on outcome in critically ill patients with acute kidney injury , 2008, Critical care.

[88]  S. Ziemer,et al.  Bleeding after intermittent or continuous r-hirudin during CVVH , 1999, Intensive Care Medicine.

[89]  R. Bellomo,et al.  Indications and criteria for initiating renal replacement therapy in the intensive care unit. , 1998, Kidney international. Supplement.

[90]  A. S. Tayade,et al.  Role of hypoalbuminemia and hypocholesterolemia as copredictors of mortality in acute renal failure. , 1999, Kidney international.

[91]  P. V. D. van der Voort,et al.  Detection of citrate overdose in critically ill patients on citrate-anticoagulated venovenous haemofiltration: use of ionised and total/ionised calcium , 2006, Clinical chemistry and laboratory medicine.

[92]  F. Gejyo,et al.  Anaphylactoid Reaction Induced by a Protease Inhibitor, Nafamostat Mesilate, following Nine Administrations in a Hemodialysis Patient , 2000, Nephron.

[93]  B. Becker,et al.  A NOVEL METHOD FOR REGIONAL CITRATE ANTICOAGULATION IN CONTINUOUS VENOVENOUS HEMOFILTRATION (CVVHF) , 2002, Renal failure.

[94]  H. Friberg,et al.  Phosphate-containing dialysis solution prevents hypophosphatemia during continuous renal replacement therapy , 2011, Acta anaesthesiologica Scandinavica.

[95]  K. Eckardt,et al.  Renal replacement strategies in the ICU. , 2007, Chest.

[96]  F. Mosca,et al.  Regional filter heparinization for continuous veno-venous hemofiltration in liver transplant recipients. , 2003, Minerva anestesiologica.

[97]  N. Maxvold,et al.  Renal failure and renal replacement therapy. , 2003, Critical care clinics.

[98]  H. O. Oudemans-van Straaten,et al.  Nadroparin versus dalteparin anticoagulation in high‐volume, continuous venovenous hemofiltration: A double‐blind, randomized, crossover study , 2000, Critical care medicine.

[99]  J. Cerdá,et al.  Renal Replacement Therapy in Special Settings: Extracorporeal Support Devices in Liver Failure , 2011, Seminars in dialysis.

[100]  C. Ronco,et al.  Delivered dose of renal replacement therapy and mortality in critically ill patients with acute kidney injury , 2009, Critical care.

[101]  R. Bellomo,et al.  Continuous veno-venous hemofiltration without anticoagulation in high-risk patients , 2000, Intensive Care Medicine.

[102]  R. Mehta,et al.  Regional Citrate Anticoagulation for Continuous Arteriovenous Hemodialysis , 1991 .

[103]  K. Klouche,et al.  Complications, effects on dialysis dose, and survival of tunneled femoral dialysis catheters in acute renal failure. , 2007, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[104]  W. van Biesen,et al.  Dialysing the patient with acute renal failure in the ICU: the emperor's clothes? , 1999, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[105]  R. Bellomo,et al.  Brain density changes during renal replacement in critically ill patients with acute renal failure. Continuous hemofiltration versus intermittent hemodialysis. , 1999, Journal of nephrology.

[106]  J. Wester,et al.  Citrate anticoagulation for continuous venovenous hemofiltration* , 2009, Critical care medicine.

[107]  G. Salazar,et al.  Malfunction of dialysis catheters: management of fibrin sheath and related problems. , 2008, Techniques in vascular and interventional radiology.

[108]  R. Pålsson,et al.  Regional citrate anticoagulation in continuous venovenous hemofiltration in critically ill patients with a high risk of bleeding. , 1999, Kidney international.

[109]  F. Gejyo,et al.  Beta 2-microglobulin: a new form of amyloid protein associated with chronic hemodialysis. , 1986 .

[110]  K. Klouche,et al.  Vascular access for extracorporeal renal replacement therapy in the intensive care unit. , 2004, Contributions to nephrology.

[111]  R. Mehta,et al.  Regional citrate anticoagulation for continuous arteriovenous hemodialysis in critically ill patients. , 1990, Kidney international.

[112]  C. Ronco,et al.  CRRT efficiency and efficacy in relation to solute size. , 1999, Kidney international. Supplement.

[113]  H. Hirasawa,et al.  Nafamostat mesylate as anticoagulant in continuous hemofiltration and continuous hemodiafiltration. , 1991, Contributions to nephrology.

[114]  R. Bellomo Do we know the optimal dose for renal replacement therapy in the intensive care unit? , 2006, Kidney international.

[115]  T. Perneger,et al.  Adding a dialysis dose to continuous hemofiltration increases survival in patients with acute renal failure. , 2006, Kidney international.

[116]  K. Wille,et al.  A practical citrate anticoagulation continuous venovenous hemodiafiltration protocol for metabolic control and high solute clearance. , 2005, Clinical journal of the American Society of Nephrology : CJASN.

[117]  T. Ortel,et al.  Clinical practice. Heparin-induced thrombocytopenia. , 2006, New England Journal of Medicine.

[118]  B. Baker,et al.  Inability of the activated partial thromboplastin time to predict heparin levels. Time to reassess guidelines for heparin assays. , 1997, Archives of internal medicine.

[119]  D. Stollery,et al.  Regional citrate versus systemic heparin anticoagulation for continuous renal replacement in critically ill patients. , 2005, Kidney international.

[120]  R. Bellomo,et al.  The role of extracorporeal therapies in sepsis. , 2003, Journal of nephrology.

[121]  A. Davenport,et al.  Changes in intracranial pressure during machine and continuous haemofiltration. , 1989, The International journal of artificial organs.

[122]  K. Tabei,et al.  Additional mechanisms of nafamostat mesilate-associated hyperkalaemia , 1996, European Journal of Clinical Pharmacology.

[123]  A. Bagga,et al.  The contrasting characteristics of acute kidney injury in developed and developing countries , 2008, Nature Clinical Practice Nephrology.

[124]  M. Kuiper,et al.  Filter Run Time in CVVH: Pre- versus Post-Dilution and Nadroparin versus Regional Heparin-Protamine Anticoagulation , 2005, Blood Purification.

[125]  R. Bellomo,et al.  A phase II randomized, controlled trial of continuous hemofiltration in sepsis , 2002, Critical care medicine.

[126]  D. Warnock,et al.  Simplified citrate anticoagulation for continuous renal replacement therapy. , 2001, Kidney international.

[127]  R. Bellomo,et al.  Management of Fluid Balance in CRRT: A Technical Approach , 2005, The International journal of artificial organs.

[128]  H. Girishkumar,et al.  Value of Ultrasound Guidance in Placement of Hemodialysis Access Catheters in Patients with End-Stage Renal Disease , 2008, The American surgeon.

[129]  A. Kribben,et al.  Regional citrate versus systemic heparin for anticoagulation in critically ill patients on continuous venovenous haemofiltration: a prospective randomized multicentre trial. , 2011, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[130]  R. Bellomo,et al.  Intensity of continuous renal-replacement therapy in critically ill patients. , 2009, The New England journal of medicine.

[131]  D. Inthorn,et al.  Comparison of pump-driven and spontaneous continuous haemofiltration in postoperative acute renal failure , 1991, The Lancet.

[132]  C. Ronco,et al.  Solute removal during continuous renal replacement therapy in critically ill patients: convection versus diffusion , 2006, Critical care.

[133]  R. Bellomo,et al.  Continuous renal replacement therapy: a worldwide practice survey. The beginning and ending supportive therapy for the kidney (B.E.S.T. kidney) investigators. , 2007, Intensive care medicine.

[134]  S. Morgera,et al.  Comparison of a lactate-versus acetate-based hemofiltration replacement fluid in patients with acute renal failure. , 1997, Renal failure.

[135]  Rinaldo Bellomo,et al.  Coupled Plasma Filtration Adsorption , 2002, Blood Purification.

[136]  K. Fischer,et al.  Recombinant hirudin (lepirudin) as anticoagulant in intensive care patients treated with continuous hemodialysis. , 1999, Kidney international. Supplement.

[137]  N. McNulty,et al.  Tunneled hemodialysis catheter outcomes in elderly patients. , 2009, Journal of vascular and interventional radiology : JVIR.

[138]  S. Tobe,et al.  Continuous veno-venous haemodialysis with a novel bicarbonate dialysis solution: prospective cross-over comparison with a lactate buffered solution. , 1999, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[139]  G. Colucci,et al.  Citrate anticoagulation in continuous venovenous hemodiafiltration: a metabolic challenge , 2002, Intensive Care Medicine.

[140]  M. Greaves,et al.  Limitations of the Laboratory Monitoring of Heparin Therapy , 2002, Thrombosis and Haemostasis.

[141]  Ciro Tetta,et al.  The Acute Dialysis Quality Initiative--part V: operational characteristics of CRRT. , 2002, Advances in renal replacement therapy.

[142]  M. Joannidis Acute kidney injury in septic shock—do not under-treat! , 2005, Intensive Care Medicine.

[143]  J. Edwards,et al.  National Healthcare Safety Network (NHSN) Report, data summary for 2006, issued June 2007. , 2007, American journal of infection control.

[144]  S. Kozek‐Langenecker Anticoagulation with prostaglandins during extracorporeal circulation. , 1999, Wiener klinische Wochenschrift.

[145]  E. Ohman,et al.  Heparin and low-molecular-weight heparin: mechanisms of action, pharmacokinetics, dosing, monitoring, efficacy, and safety. , 2001, Chest.

[146]  A. Davenport,et al.  Volume Management by Renal Replacement Therapy in Acute Kidney Injury , 2008, The International journal of artificial organs.

[147]  M. Mathru Intensity of Continuous Renal-Replacement Therapy in Critically Ill Patients , 2010 .

[148]  L. Kramer,et al.  Citrate pharmacokinetics and metabolism in cirrhotic and noncirrhotic critically ill patients , 2003, Critical care medicine.

[149]  M. Betjes,et al.  Regional citrate versus heparin anticoagulation during venovenous hemofiltration in patients at low risk for bleeding: similar hemofilter survival but significantly less bleeding. , 2007, Journal of nephrology.

[150]  Michael K Gould,et al.  Preventing complications of central venous catheterization. , 2003, The New England journal of medicine.

[151]  M. Allon,et al.  Vascular access: core curriculum 2008. , 2008, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[152]  M. Oliver Acute Dialysis Catheters , 2001, Seminars in dialysis.

[153]  R. MacLaren,et al.  Bivalirudin versus Unfractionated Heparin for Prevention of Hemofilter Occlusion During Continuous Renal Replacement Therapy , 2010, Pharmacotherapy.

[154]  A. Kribben,et al.  A new system for regional citrate anticoagulation in continuous venovenous hemodialysis (CVVHD). , 2003, Clinical nephrology.

[155]  Francesco Locatelli,et al.  The importance of convective transport. , 2002, Kidney international. Supplement.

[156]  B. Venkatesh,et al.  Noninvasive rodent cardiac output: comparison of a compact clinical monitor with echocardiography and proposal of a simple correction factor , 2008, Critical Care.

[157]  W. Clark,et al.  Dose determinants in continuous renal replacement therapy. , 2003, Artificial organs.

[158]  G. Leslie,et al.  Proximally delivered dilute heparin does not improve circuit life in continuous venovenous haemodiafiltration , 1996, Intensive Care Medicine.

[159]  P. Plášil,et al.  Prostacyclin versus Citrate in Continuous Haemodiafiltration: An Observational Study in Patients with High Risk of Bleeding , 2005, Blood Purification.

[160]  J. Seeger Femoral vs Jugular Venous Catheterization and Risk of Nosocomial Events in Adults Requiring Acute Renal Replacement Therapy: A Randomized Controlled Trial , 2009 .

[161]  C. Ronco,et al.  Hirudin versus heparin for anticoagulation in continuous renal replacement therapy , 2001, Intensive Care Medicine.

[162]  J. Hall,et al.  Renal replacement therapy for acute renal failure. , 2000, American journal of respiratory and critical care medicine.

[163]  M. Leblanc,et al.  Cooling effect of continuous renal replacement therapy in critically ill patients. , 1998, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[164]  U. Maggiore,et al.  Continuous haemofiltration in acute renal failure with prostacyclin as the sole anti-haemostatic agent , 2002, Intensive Care Medicine.

[165]  J Ean,et al.  Efficacy and safety of recombinant human activated protein C for severe sepsis. , 2001, The New England journal of medicine.

[166]  Daniel Parent,et al.  Solute clearances during continuous venovenous haemofiltration at various ultrafiltration flow rates using Multiflow-100 and HF1000 filters. , 2003, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[167]  L. Weisberg,et al.  Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury , 2010 .

[168]  J. Cerdá,et al.  In severe acute kidney injury, a higher serum creatinine is paradoxically associated with better patient survival. , 2007, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[169]  R. Bellomo,et al.  A Comparison of Two Citrate Anticoagulation Regimens for Continuous Veno-Venous Hemofiltration , 2005, The International journal of artificial organs.

[170]  S. Opal,et al.  Coagulation abnormalities in critically ill patients , 2006, Critical care.

[171]  P. Vadgama,et al.  Comparison of lactate and bicarbonate buffered haemofiltration fluids: use in critically ill patients. , 1997, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[172]  A G Randolph,et al.  Ultrasound guidance for placement of central venous catheters: a meta-analysis of the literature. , 1996, Critical care medicine.

[173]  E. Lindhoff‐Last,et al.  Use of a Low-Molecular-Weight Heparinoid (Danaparoid Sodium) for Continuous Renal Replacement Therapy in Intensive Care Patients , 2001, Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis.

[174]  J. Cerdá,et al.  Renal Replacement Therapy in Special Situations: Heart Failure and Neurological Injury , 2011, Seminars in dialysis.

[175]  R. Bellomo,et al.  Interpreting the mechanisms of continuous renal replacement therapy in sepsis: the peak concentration hypothesis. , 2003, Artificial organs.

[176]  R. Mehta,et al.  Regional citrate anticoagulation for continuous arteriovenous hemodialysis. An update after 12 months. , 1991, Contributions to nephrology.

[177]  P. Thomson,et al.  Vascular access in haemodialysis patients: a modifiable risk factor for bacteraemia and death. , 2007, QJM : monthly journal of the Association of Physicians.

[178]  E. Schmid,et al.  Regional citrate anticoagulation using a citrate-based substitution solution for continuous venovenous hemofiltration in cardiac surgery patients. , 2002, Wiener klinische Wochenschrift.

[179]  F. Locatelli,et al.  Sodium removal during pre-dilution haemofiltration. , 2003, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[180]  R. Mehta Indications for Dialysis in the ICU: Renal Replacement vs. Renal Support , 2000, Blood Purification.

[181]  A. Greinacher,et al.  Monitoring of r-Hirudin Anticoagulation during Cardiopulmonary Bypass – Assessment of the Whole Blood Ecarin Clotting Time , 1997, Thrombosis and Haemostasis.

[182]  E. Will,et al.  Anticoagulation with low molecular weight heparin (Fragmin) during continuous hemodialysis in the intensive care unit. , 2008, Artificial organs.

[183]  M. Schetz Vascular access for HD and CRRT. , 2007, Contributions to nephrology.

[184]  E. Grossman,et al.  Argatroban Anticoagulation in Patients with Heparin-Induced Thrombocytopenia Requiring Renal Replacement Therapy , 2005, The Annals of pharmacotherapy.

[185]  R. Bellomo,et al.  Cytokine Removal during Continuous Renal Replacement Therapy: An Ex Vivo Comparison of Convection and Diffusion , 2004, The International journal of artificial organs.

[186]  D. Smith,et al.  Complications of central venous cannulation. , 1988, BMJ.

[187]  J. Kellum,et al.  Fluids for Prevention and Management of Acute Kidney Injury , 2008, The International journal of artificial organs.

[188]  T. Tani,et al.  Direct hemoperfusion with polymyxin-B-immobilized fiber columns improves septic hypotension and reduces inflammatory mediators in septic patients with colorectal perforation , 2009, Langenbeck's Archives of Surgery.

[189]  R. Westendorp,et al.  Heparin use in continuous renal replacement procedures: the struggle between filter coagulation and patient hemorrhage. , 1996, Journal of the American Society of Nephrology : JASN.

[190]  S. Fedak,et al.  Blood recirculation in temporary central catheters for acute hemodialysis. , 1996, Clinical nephrology.

[191]  C. Ronco,et al.  Extracorporal blood purification: more than diffusion and convection. Does this help? , 2007, Current opinion in critical care.

[192]  H. Büller,et al.  Treatment with recombinant human activated protein C obviates additional anticoagulation during continuous venovenous hemofiltration in patients with severe sepsis , 2003, Intensive Care Medicine.

[193]  S. Morabito,et al.  Continuous renal replacement therapies: anticoagulation in the critically ill at high risk of bleeding. , 2003, Journal of nephrology.

[194]  I. Mayers,et al.  Regional citrate anticoagulation in continuous venovenous hemodiafiltration. , 2000, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[195]  J. Kellum,et al.  Dosing patterns for continuous renal replacement therapy at a large academic medical center in the United States. , 2002, Journal of critical care.

[196]  J. Horrow Protamine: A Review of its Toxicity , 1985, Anesthesia and analgesia.

[197]  C. Zauner,et al.  Impairment of citrate metabolism in acute hepatic failure. , 1997, Wiener klinische Wochenschrift.

[198]  H. Ulmer,et al.  Enoxaparin vs. unfractionated heparin for anticoagulation during continuous veno-venous hemofiltration: a randomized controlled crossover study , 2007, Intensive Care Medicine.

[199]  R. Bellomo,et al.  Dose of dialysis in acute renal failure. , 2006, Clinical journal of the American Society of Nephrology : CJASN.

[200]  M. Schetz Drug dosing in continuous renal replacement therapy: general rules , 2007, Current opinion in critical care.

[201]  D. Matthaei,et al.  Arteriovenous haemofiltration: A new and simple method for treatment of over-hydrated patients resistant to diuretics , 1977, Klinische Wochenschrift.

[202]  J. Victorino,et al.  Enoxaparin versus unfractioned heparin as anticoagulant for continuous venovenous hemodialysis: a randomized open-label trial , 2010, Renal failure.

[203]  Norbert Lameire,et al.  Epidemiology of acute kidney injury. , 2008, Clinical journal of the American Society of Nephrology : CJASN.

[204]  Imad F. Btaiche,et al.  Metabolic and nutritional aspects of acute renal failure in critically ill patients requiring continuous renal replacement therapy. , 2005, Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition.

[205]  J. Cerdá Low serum creatinine is associated with higher mortality among critically ill patients. , 2008, Critical care medicine.

[206]  J. Flynn,et al.  Choice of dialysis modality for management of pediatric acute renal failure , 2002, Pediatric Nephrology.

[207]  R. Bellomo,et al.  High-volume haemofiltration in human septic shock , 2001, Intensive Care Medicine.