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Abstract

The incidence of sepsis is around 6% of patients in the hospital. Sepsis that is not manage properly will develop into septic shock which will increase mortality by 50-70%. Acute Renal Failure (ARF) occurs in 58-87% of patients with septic shock. In 70% of cases of ARF caused by sepsis can worsen and require renal replacement therapy (RRT). Continuous Renal Replacement Therapy (CRRT) is a good RRT modality for septic shock patients.


A 51 year old male, referred from the ICU another hospital with a diagnosis of respiratory failure, septic shock, Hospital Associated Pneumonia (HAP), diabetic foot with osteomyelitis pedis dextra, ARF Stage 3 and Type 2 Diabetic Mellitus (DM). From the clinical sign, patient was shortness of breath, decreased consciousness, accompanied by shock requiring a vasopressor and from the laboratory obtained urea 277 mg/dl and chest X-ray obtained the impression of pneumonia. The management of this patient was administration of antibiotics, amputation of the right leg and CRRT as a therapeutic modality for ARF. CRRT was performed in Continuous Venovenous Hemodialysis (CVVHDF) mode for 3 days. On the fifth day the  patient conditiont improved so he could be discharge from the ICU.


At septic shock with ARF, CRRT can maintain hemodynamic stability of patients, remove toxins from the kidneys, remove cytokines and endotoxins, correct acid-base and electrolytes, control fluid volume appropriately, modulate the immune response thereby accelerating renal recovery and improving clinical conditions patient.

Article Details

How to Cite
Fatoni, A. Z., Rusly, A., & Hartono, R. (2023). Management Continuous Renal Replacement Therapy (CRRT) In Acute Renal Failure and Septic Shock In ICU. Jurnal Klinik Dan Riset Kesehatan, 2(2), 305-314. https://doi.org/10.11594/jk-risk.02.2.7

References

1. Hidayati H, Arifin H, Raveinal R. Kajian Penggunaan Antibiotik pada Pasien Sepsis dengan Gangguan Ginjal. JSFK. 2016;2(2):129–37.
2. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: International Guidelines for Man-agement of Sepsis and Septic Shock: 2016. In-tensive Care Med. 2017 Mar;43(3):304–77.
3. Alliance GS. Toolkits. 2018.
4. Rhee C, Dantes R, Epstein L, Murphy DJ, Sey-mour CW, Iwashyna TJ, et al. Incidence and Trends of Sepsis in US Hospitals Using Clinical vs Claims Data, 2009-2014. JAMA. 2017 Oct;318(13):1241–9.
5. Vincent J-L, Moore F. Septic Shock. In: Textbook of Critical Care. 7th ed. Elsevier Philadelphia; 2016. p. 843.
6. Sartelli M, Chichom-Mefire A, Labricciosa FM, Hardcastle T, Abu-Zidan FM, Adesunkanmi AK, et al. The management of intra-abdominal in-fections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections. World J Emerg Surg. 2017;12:29.
7. Neyra JA, Li X, Canepa-Escaro F, Adams-Huet B, Toto RD, Yee J, et al. Cumulative Fluid Balance and Mortality in Septic Patients With or Without Acute Kidney Injury and Chronic Kidney Dis-ease. Crit Care Med. 2016 Oct;44(10):1891–900.
8. Zhang J, Tian J, Sun H, Digvijay K, Neri M, Bhar-gava V, et al. How Does Continuous Renal Re-placement Therapy Affect Septic Acute Kidney Injury? Blood Purif. 2018;46(4):326–31.
9. Yu G, Cheng K, Liu Q, Wu W, Hong H, Lin X. Clinical outcomes of severe sepsis and septic shock patients with left ventricular dysfunction undergoing continuous renal replacement ther-apy. Sci Rep. 2022 Jun;12(1):9360.
10. Karkar A, Ronco C. Prescription of CRRT: a pathway to optimize therapy. Ann Intensive Care. 2020 Mar;10(1):32.
11. Bonnassieux M, Duclos A, Schneider AG, Schmidt A, Bénard S, Cancalon C, et al. Renal Replacement Therapy Modality in the ICU and Renal Recovery at Hospital Discharge. Crit Care Med. 2018 Feb;46(2):e102–10.
12. Rum M, Muchtar F, Arif SK. Penatalaksa-naan Syok Sepsis pada Pasien Community Ac-quired Pneumonia Pasca Stroke Iskemik dengan Disfungsi Organ. J Anest dan Crit Care. 2019;37(3):107–19.
13. Fatoni AZ, Suwarman, Hariyanto H, Tam-pubolon OE, Jaya W. Low-dose heparin for sep-sis-associated disseminated intravascular co-agulation and septic shock. Crit Care Shock. 2020;23(5):260–5.
14. Fatoni AZ, Kestriani ND. Acute Kidney Inju-ry (AKI) pada Pasien Kritis. Maj Anest dan Crit Care. 2018;36(2):64–75.
15. Hanafusa N. Application of Continuous Re-nal Replacement Therapy: What Should We Consider Based on Existing Evidence? Blood Purif. 2015;40(4):312–9.
16. Tandukar S, Palevsky PM. Continuous Renal Replacement Therapy: Who, When, Why, and How. Chest. 2019 Mar;155(3):626–38.
17. Hall NA, Fox AJ. Renal replacement thera-pies in critical care. Contin Educ Anaesth Crit Care Pain [Internet]. 2006 Oct 1;6(5):197–202. Available from: https://doi.org/10.1093/bjaceaccp/mkl038
18. Gemmell L, Docking R, Black E. Renal re-placement therapy in critical care. BJA Educ [In-ternet]. 2017;17(3):88–93. Available from: https://www.sciencedirect.com/science/article/pii/S2058534917300926
19. Page B, Vieillard-Baron A, Chergui K, Pey-rouset O, Rabiller A, Beauchet A, et al. Early veno-venous haemodiafiltration for sepsis-related multiple organ failure. Crit Care. 2005;9(6):R755-63.
20. Wald R, Shariff SZ, Adhikari NKJ, Bagshaw SM, Burns KEA, Friedrich JO, et al. The associa-tion between renal replacement therapy modal-ity and long-term outcomes among critically ill adults with acute kidney injury: a retrospective cohort study*. Crit Care Med. 2014 Apr;42(4):868–77.
21. Ye Z, Wang Y, Ge L, Guyatt GH, Collister D, Alhazzani W, et al. Comparing Renal Replace-ment Therapy Modalities in Critically Ill Patients With Acute Kidney Injury: A Systematic Review and Network Meta-Analysis. Crit care Explor. 2021 May;3(5):e0399.
22. Schneider AG, Bellomo R, Bagshaw SM, Glassford NJ, Lo S, Jun M, et al. Choice of renal replacement therapy modality and dialysis de-pendence after acute kidney injury: a system-atic review and meta-analysis. Intensive Care Med. 2013 Jun;39(6):987–97.
23. McPhee JT, Hill JS, Whalen GF, Zayaruzny M, Litwin DE, Sullivan ME, et al. Perioperative Mor-tality for Pancreatectomy: A National Perspec-tive. Ann Surg [Internet]. 2007;246(2). Availa-ble from: https://journals.lww.com/annalsofsurgery/Fulltext/2007/08000/Perioperative_Mortality_for_Pancreatectomy__A.13.aspx
24. Boka K. Systemic Inflammatory Response Syndrome (SIRS) [Internet]. Medscape. 2020. Available from: https://emedicine.medscape.com/article/168943-overview