Background/Aims: The incidence of adverse events (AEs) in adults who receive continuous renal replacement therapy (CRRT) is unknown. We report the incidence of mechanical, metabolic, and hemodynamic CRRT AEs. Methods: This is a retrospective study of all consecutive adult patients (≥18 years) who underwent CRRT from January 1, 2007 to December 31, 2009. Results: Out of 595 patients who underwent CRRT, 366 (62%) were male and 500 (84%) were Caucasian. Regional citrate anticoagulation was used in 98.6% of all patients. The most common clinically significant electrolyte derangements were ionized hypocalcemia (22%), ionized hypercalcemia (23%), and hyperphosphatemia (44%). Almost all (97%) patients had at least one additional AE including new onset hypotension (within the first hour after CRRT initiation) (43%), hypothermia (44%), new onset arrhythmias (29%), new onset anemia (31%) and thrombocytopenia (40%). Conclusions: ICU patients who require CRRT have a high incidence of AEs. Although the extent to which these complications are attributable to CRRT is not known, clinicians need to be cautious and aware of their high prevalence in this patient population.

Keywords:
Kidney failure, Dialysis, Complication, Adverse event, CRRT, AKI
1.
Liangos O, Wald R, O'Bell JW, Price L, Pereira BJ, Jaber BL: Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey. Clin J Am Soc Nephrol 2006;1:43-51.
2.
Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Ronco C: Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 2005;294:813-818.
3.
Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, De Bacquer D, Kellum JA: RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care 2006;10:R73.
4.
Joannidis M, Metnitz B, Bauer P, Schusterschitz N, Moreno R, Druml W, Metnitz PG: Acute kidney injury in critically ill patients classified by AKIN versus RIFLE using the SAPS 3 database. Intensive Care Med 2009;35:1692-1702.
5.
Shingarev R, Wille K, Tolwani A: Management of complications in renal replacement therapy. Semin Dial 2011;24:164-168.
6.
Zhang W, Shen PY, Chen YX, Zhu P, Shi H, Li X, Xu YW, Ren H, Chen N: Analyzing Chinese patients with post-operative acute kidney injury. Ren Fail 2011;33:795-800.
7.
Vats HS, Dart RA, Okon TR, Liang H, Paganini EP: Does early initiation of continuous renal replacement therapy affect outcome: experience in a tertiary care center. Ren Fail 2011;33:698-706.
8.
John S, Eckardt KU: Renal replacement strategies in the ICU. Chest 2007;132:1379-1388.
9.
Zhou F, Song Q, Peng Z, Pan L, Kang H, Tang S, Yue H, Liu H, Xie F: Effects of continuous venous-venous hemofiltration on heat stroke patients: a retrospective study. J Trauma 2011;71:1562-1568.
10.
Zhang L, Kang Y, Fu P, Cao Y, Shi Y, Liu F, Hu Z, Su B, Tang W, Qin W: Myoglobin clearance by continuous venous-venous haemofiltration in rhabdomyolysis with acute kidney injury: a case series. Injury 2012;43:619-623.
11.
Kron J, Kron S, Wenkel R, Schuhmacher HU, Thieme U, Leimbach T, Kern H, Neumayer HH, Slowinski T: Extended daily on-line high-volume haemodiafiltration in septic multiple organ failure: a well-tolerated and feasible procedure. Nephrol Dial Transplant 2012;27:146-152.
12.
Fall P, Szerlip HM: Continuous renal replacement therapy: cause and treatment of electrolyte complications. Semin Dial 2010;23:581-585.
13.
Cerdá J, Tolwani AJ, Warnock DG: Critical care nephrology: management of acid-base disorders with CRRT. Kidney Int 2012;82:9-18.
14.
Pedersen O, Jepsen SB, Toft P: Continuous renal replacement therapy for critically ill infants and children. Dan Med J 2012;59:A4385.
15.
Finkel KW, Podoll AS: Complications of continuous renal replacement therapy. Semin Dial 2009;22:155-159.
16.
Kemper MJ, Villiez MV, Muller-Wiefel DE: Outcome of continuous veno-venous hemofiltration (CVVH) in children: single centre study. Pediatr Nephrol 2010;25:1587-1588.
17.
Santiago MJ, López-Herce J, Urbano J, Solana MJ, Del Castillo J, Ballestero Y, Botrán M, Bellón JM: Complications of continuous renal replacement therapy in critically ill children: a prospective observational evaluation study. Crit Care 2009;13:R184.
18.
Balogun RA, Turgut F, Caldwell S, Abdel-Rahman EM: Regional citrate anticoagulation in critically ill patients with liver and kidney failure. J Nephrol 2012;25:113-119.
19.
Symons JM, Chua AN, Somers MJ, Baum MA, Bunchman TE, Benfield MR, Brophy PD, Blowey D, Fortenberry JD, Chand D, Flores FX, Hackbarth R, Alexander SR, Mahan J, McBryde KD, Goldstein SL: Demographic characteristics of pediatric continuous renal replacement therapy: a report of the prospective pediatric continuous renal replacement therapy registry. Clin J Am Soc Nephrol 2007;2:732-738.
20.
Fernández C, López-Herce J, Flores JC, Galaviz D, Rupérez M, Brandstrup KB, Bustinza A: Prognosis in critically ill children requiring continuous renal replacement therapy. Pediatr Nephrol 2005;20:1473-1477.
21.
Goldstein SL: Overview of pediatric renal replacement therapy in acute kidney injury. Semin Dial 2009;22:180-184.
22.
Pichler G, Rödl S, Mache C, Trop M, Ring E, Zobel G: Two decades' experience of renal replacement therapy in paediatric patients with acute renal failure. Eur J Pediatr 2007;166:139-144.
23.
Ronco C, Bellomo R: Complications with continuous renal replacement therapy. Am J Kidney Dis 1996;28:S100-S104.
24.
Herasevich V, Pickering BW, Dong Y, Peters SG, Gajic O: Informatics infrastructure for syndrome surveillance, decision support, reporting, and modeling of critical illness. Mayo Clin Proc 2010;85:247-254.
25.
Alsara A, Warner DO, Li G, Herasevich V, Gajic O, Kor DJ: Derivation and validation of automated electronic search strategies to identify pertinent risk factors for postoperative acute lung injury. Mayo Clin Proc 2011;86:382-388.
26.
Singh B, Singh A, Ahmed A, Wilson GA, Pickering BW, Herasevich V, Gajic O, Li G: Derivation and validation of automated electronic search strategies to extract charlson comorbidities from electronic medical records. Mayo Clin Proc 2012;87:817-824.
27.
Singh B, Singh A, Giri J, Kaur R, Wilson G, Herasevich V, Gajic O, Li G: Evaluation of digital signature of charlson comorbidities using automatic electronic note search strategies in critically ill patients. Crit Care Med 2011;39:160.
28.
Singh B, Singh A, Ahmed A, Wilson GA, Pickering BW, Herasevich V, Gajic O, Li G: Derivation and validation of automated electronic search strategies to extract charlson comorbidities from electronic medical records. Mayo Clin Proc 2012;87:817-824.
29.
Schönenberger M, Forster C, Siegemund M, Woodtli S, Widmer AF, Dickenmann M: Catheter related blood stream infections in critically ill patients with continuous haemo(dia)filtration and temporary non-tunnelled vascular access. Swiss Med Wkly 2011;141:w13294.
30.
Saha S, Shah P, Gibbs J, Collins J: Effect of site of haemofilter catheter on the duration of haemofilter circuit. Intensive Care Med 2011;37:S129.
31.
Graham AS, Ozment C, Tegtmeyer K, Lai S, Braner DA: Videos in clinical medicine. Central venous catheterization. N Engl J Med 2007;356:e21.
32.
Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, Kaul S, Wiviott SD, Menon V, Nikolsky E, Serebruany V, Valgimigli M, Vranckx P, Taggart D, Sabik JF, Cutlip DE, Krucoff MW, Ohman EM, Steg PG, White H: Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the bleeding academic research consortium. Circulation 2011;123:2736-2747.
33.
American college of chest physicians/society of critical care medicine consensus conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992;20:864-874.
34.
Konopka A, Banaszewski M, Wojtkowska I, Stępińska J: Early implementation of continuous venovenous haemodiafiltration improves outcome in patients with heart failure complicated by acute kidney injury. Kardiol Pol 2011;69:891-896.
35.
Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A: Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11:R31.
36.
U.S. Department of Health and Human Service, National Institutes of Health, National Cancer Institute: Common Terminology Criteria for Adverse Events (CTCAE). Bethesda, MD, National Institutes of Health, 2010.
37.
Parienti JJ, Thirion M, Mégarbane B, Souweine B, Ouchikhe A, Polito A, Forel JM, Marqué S, Misset B, Airapetian N, Daurel C, Mira JP, Ramakers M, du Cheyron D, Le Coutour X, Daubin C, Charbonneau P: Femoral vs jugular venous catheterization and risk of nosocomial events in adults requiring acute renal replacement therapy: a randomized controlled trial. JAMA 2008;299:2413-2422.
38.
Demirjian S, Teo BW, Guzman JA, Heyka RJ, Paganini EP, Fissell WH, Schold JD, Schreiber MJ: Hypophosphatemia during continuous hemodialysis is associated with prolonged respiratory failure in patients with acute kidney injury. Nephrol Dial Transplant 2011;26:3508-3514.
39.
Robert R, Méhaud JE, Timricht N, Goudet V, Mimoz O, Debaene B: Benefits of an early cooling phase in continuous renal replacement therapy for ICU patients. Ann Intensive Care 2012;2:40.
40.
Parienti JJ, Dugué AE, Daurel C, Mira JP, Mégarbane B, Mermel LA, Daubin C, du Cheyron D; Members of the Cathedia Study Group: Continuous renal replacement therapy may increase the risk of catheter infection. Clin J Am Soc Nephrol 2010;5:1489-1496.
41.
Uchino S, Bellomo R, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Oudemans-van Straaten H, Ronco C, Kellum JA: Continuous renal replacement therapy: a worldwide practice survey. The beginning and ending supportive therapy for the kidney (B.E.S.T. kidney) investigators. Intensive Care Med 2007;33:1563-1570.
42.
Lin YF, Ko WJ, Chu TS, Chen YS, Wu VC, Chen YM, Wu MS, Chen YW, Tsai CW, Shiao CC, Li WY, Hu FC, Tsai PR, Tsai TJ, Wu KD: The 90-day mortality and the subsequent renal recovery in critically ill surgical patients requiring acute renal replacement therapy. Am J Surg 2009;198:325-332.
© 2015 S. Karger AG, Basel
2015
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.