When is acute renal replacement therapy used?
In the case of acute kidney injury and the associated deterioration in kidney function, for example after accidents, serious operations or multi-organ failure, continuous renal replacement therapy is often necessary 24 hours a day, seven days a week.
How does the procedure work?
The blood is continuously fed through the special filter outside the body (extracorporeal) via a central venous catheter. In order to make this possible, the natural coagulation function of the blood must be temporarily inhibited.
In clinical practice, citrate has now proven itself as a regional anticoagulant compared to systemic anticoagulation with heparin, and is recommended accordingly [KDIGO, 2012]. Citrate acts exclusively in the extracorporeal blood circuit and hardly affects the bleeding situation in the patient. It is therefore ideal for patients who are at risk of bleeding. Three continuous veno-venous procedures are in use. The two main methods are briefly described below.
Haemofiltration
In continuous haemofiltration (continuous veno-venous haemofiltration, CVVH) an ultrafiltrate is filtered out of the blood via a semi-permeable membrane by means of convection. This is replaced in whole or in part by a suitable substitution solution. The advantage: Cytokines and interleukins up to 25 kDa can be removed more intensively than with haemodialysis. The kidney works in a similar way: It also haemofiltrates, the driver of convection is the blood pressure. Continuous haemofiltration comes closest to the human kidney. In Germany, it is reimbursed at the highest level nationwide in clinics via DRG (Diagnosis Related Groups) additional fees.
Haemodialysis
During continuous haemodialysis (continuous veno-venous haemodialysis, CVVHD) the substances to be removed pass by diffusion across a semipermeable membrane into a dialysate flowing outside the membrane. The patient does not receive a replacement solution.
For both methods (CVVH/CVVHD) there are reliable and well-published citrate protocols for the automated application of regional anticoagulation with citrate.
What are the advantages?
Complex work processes in everyday clinical practice and the ongoing shortage of nursing staff result in a high level of workload in the intensive care units. Extracorporeal renal replacement as an acute therapy should be integrated into this area of tension. With Plasauto SIGMA, the market leader in Japan, this has been outstandingly achieved. Have work done for you and convince yourself of the versatility of this device for acute renal replacement in intensive care units.
Special features of acute renal replacement using Plasauto SIGMA:
- quick learning by means of graphically supported and guided setup
- all common procedures of acute renal replacement therapy: CVVH pre/post dilution, CVVHD, CVVHDF pre/post dilution, SCUF
- one CRRT therapy set for all acute renal replacement procedures; flexible change between the procedures, even during therapy
- free choice between heparin and citrate anticoagulation
- a special paediatric therapy cassette with a particularly small filling volume (only 47ml): maximum safety even for the youngest and smallest patients; no weight limit
- innovative balancing with chamber system without bag scales:
- free and shock-resistant suspension of the treatment solutions
- prevents alarms, reduces actions on the device
- no emptying and disposal of collection bags necessary (cost and time savings)
- automatic restart of the blood pump after an arterial alarm
- high reliability
- long treatment times of up to 72 hours
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Plasauto SIGMA - the market leader from Japan - for continuous renal replacement therapy and therapeutic apheresis. Suitable even for the youngest and smallest patients! Whether citrate or heparin, outpatient or inpatient - the choice is yours!
The following information is intended for healthcare professionals only.
The information in the section ‚products & therapies‘ is intended to provide explanatory, scientific, and evidence-based answers to medical questions about therapeutic apheresis.
This information does not constitute medical advice. The responsibility for patient care rests with the healthcare professional based on their professional licensure, experience, and knowledge of the patient.