Clinical effects of combination therapy with continuous renal replacement therapy and continuous intravenous sodium infusion therapy

Abstract

Introduction: This single-center retrospective study investigated the clinical effects of combination therapy involving continuous renal replacement therapy (CRRT) and continuous intravenous sodium infusion therapy (cIVNa) in critically ill patients with prerenal acute kidney injury (AKI) who were expected to experience insufficient plasma refilling.

Method: The clinical data of 92 patients were analyzed. Clinical data from the control (CRRT, n = 49) and intervention (CRRT + cIVNa, n = 43) groups were compared statistically.

Results: Combination therapy increased blood pressure and urine volume, while reducing hypotension events, indicating hemodynamic stabilization. Furthermore, it significantly improved the 90-day survival rate (61.9% vs. 38.8%, p < 0.05), 60-day and 90-day survival rates without RRT (59.5% vs. 28.6%, p < 0.01; 54.8% vs. 26.5%, p < 0.01, respectively), survival discharge rate from intensive care unit, CRRT withdrawal rate, and renal replacement therapy withdrawal rate.

Conclusion: Combination therapy with continuous renal replacement therapy and continuous intravenous sodium infusion therapy may be a useful treatment option for critically ill patients with prerenal acute kidney injury who require continuous renal replacement therapy.

Keywords: acute kidney injury; continuous renal replacement therapy; high‐sodium dialysate; multimodal approach; plasma refilling.

FIGURE 1

Study flowchart. Adult patients with acute kidney injury (AKI) (n = 194) treated with continuous renal replacement therapy (CRRT) in the intensive care unit (ICU) between January 2015 and December 2022 were included. To investigate the interventional therapeutic effects in adult patients with prerenal AKI, who were expected to have impaired plasma refilling, patients who met the exclusion criteria were excluded. The clinical data between the control (conventional CRRT, n = 49) and intervention (CRRT + cIVNa, n = 43) groups were compared statistically. cIVNa, continuous intravenous sodium infusion; eGFR, estimated glomerular filtration rate; IHD, intermittent hemodialysis therapy.

FIGURE 2

Conceptual model of substituting continuous intravenous sodium infusion therapy for using high‐sodium dialysate. In continuous renal replacement therapy (CRRT), the dialysate is in contact with the blood through the CRRT dialysis membrane. Through this process, sodium is transferred from the high‐sodium dialysate to the blood. This sodium movement was substituted with continuous intravenous sodium infusion therapy (cIVNa).

FIGURE 3

Main outcomes and complications. Outcomes and complications for which significant differences were detected between the control and intervention group are presented. Variables are presented as numbers (percentages) and were compared using the Fisher's exact test. “CRRT withdrawal” was defined as surviving for >7 days without CRRT after its discontinuation. “RRT withdrawal” was defined as surviving for >7 days without RRT after its discontinuation. “Hypotension requiring intervention” was defined as hypotension requiring an increase in vasopressor dose and/or rapid volume loading. CRRT, continuous renal replacement therapy; ICU, intensive care unit; RRT, renal replacement therapy.

FIGURE 4

Changes in systolic blood pressure and urine volume. Systolic blood pressure was measured every 24 h after CRRT initiation. Urine volume data were collected from 6 a.m. on the same day to 6 a.m. the following day, excluding data from the day of death and discharge. p values are shown when significant differences were detected between variables in the control and intervention groups.