The issues with early continuous renal replacement therapy for National Health Insurance patients: a case report | [Anaesthesia, Pain and Intensive Care • 2024]

Author(s):

1. Anne Suwan Djaja: Department of Anesthesiology & Intensive Care Department, Faculty of Medicine, University of Indonesia,Jakarta,Indonesia

2. Adhrie Sugiarto: Department of Anesthesiology & Intensive Care Cipto Mangunkusumo General Hospital, Faculty of Medicine, University of Indonesia,Jakarta,Indonesia

3. Vera Irawany: Department of Anesthesiology & Intensive Care Fatmawati General Hospital,Jakarta,Indonesia

Abstract:

Sepsis is the leading cause of patient admission to the intensive care unit (ICU). Most of the sepsis patients experience multi-organ failure, such as respiratory and kidney failure, that require specific support. Continuous renal replacement therapy (CRRT) is one of the modalities performed in the ICU to help ameliorate cytokine levels, maintain fluid balance, and remove toxins. CRRT allows early ventilator weaning, a reduction in vasopressor or inotropic administration, and early discharge from the ICU. We report an experience of initiating an early CRRT in a patient with septic shock and acute kidney injury with fluid overload. During CRRT, the patient showed significant improvement in ventilation, hemodynamic, and fluid balance. However, the CRRT had to be discontinued due to limited resources and the infection rebounded. The patient in this case study died on the 14th day following admission. Early CRRT may be an effective therapy in septic shock patients; however, it requires continuous application that may not be possible in low-resource setting. Alternatively, sustained low-efficiency daily dialysis (SLEDD) has no major disadvantages compared to CRRT and may be a feasible option.

Page(s): 380-383

DOI: 10.35975/apic.v28i2.2417

Published: Journal: Anaesthesia, Pain and Intensive Care, Volume: 28, Issue: 2, Year: 2024

Keywords:

Sepsis , CRRT , Continuous renal replacement therapy , Blood purification , Lowresource setting

References:

[1] Sakr Y,Jaschinski U,Wittebole X,Szakmany T,Lipman J,Ñamendys-Silva SA .2012 .An Introduction to Extracorporeal Blood Purification in Critical Illness. Proceedings of Singapore Healthcare, 19(12) : .

[2] Rhodes A,Alhazzani W,Antonelli M,Coopersmith CM,French C,Karkar A,Ronco C . .Prescription of CRRT: a pathway to optimize therapy. 2020 Mar, 6(1) : 32-e1143.

[3] Yoon BR,Leem AY,Park MS,Kim YS,Chung KS,Gaudry S,Hajage D,Schortgen F,Martin-Lefevre L,Pons B,Boulet E,Christiansen S,Christensen S,Pedersen L,Gammelager H,Layton JB,Brookhart MA . .Timing of renal replacement therapy and long-term risk of chronic kidney disease and death in intensive care patients with acute kidney injury. Crit Care., 14(2) : 122-33.

[4] -y Huang ACC,Lee TYT,Ko MC,Huang CH,Wang TY,Lin TY . .Fluid balance correlates with clinical course of multiple organ dysfunction syndrome and mortality in patients with septic shock. 2019 Dec, 2(12) : e0225423.

[5] Wang M,Zhu B,Jiang L,Luo X,Wang N,Zhu Y . .. PMID: 31790451; PMCID: PMC6886786; DOI: 10, : .

[6] Alorf S,Alotaibi R,Altheaby M,Alghamdi A,Ghazal Y,H Y . .:e28118. PMID: 34941056; PMCID: PMC8702221; DOI: 10, 100(51) : 82-92.

Citations

Downloads

Views