This is a multicenter, prospective, registry study. By collecting relevant demographic information and clinical data of patients receiving continuous renal replacement therapy (CRRT) with pre-mixed solutions, the clinical applicability of pre-mixed solutions will be evaluated in critically ill patients in real-world clinical settings. This study will be carried out in approximately 10 study sites in China. Patient data will be collected to evaluate the clinical applicability of pre-mixed solutions.
Treatment observation period: From initiation of the first CRRT with sponsored pre-mixed solutions to cessation of the pre-mixed solutions. The duration of this period can be up to 10 days. Follow-up period: from the cessation of sponsored pre-mixed solutions to Day 30 after starting treatment with the pre-mix solutions.
Study Type
OBSERVATIONAL
Enrollment
220
Regiocit can be used as a replacement fluid for CRRT with RCA. It will be used in pre-dilution mode only. At least 200 mL of post-replacement solution is recommended to minimize clotting in the de-aeration chamber. A replacement/dialysate solution with 22 to 26 mEq/L bicarbonate buffer is advised as the first choice. A higher concentration of bicarbonate may be required in severe cases of acidosis. The use of a non-calcium-containing dialysate or replacement fluid is advised. The rate of administration depends on the targeted citrate dose and the prescribed flow rate. The pre-filter infusion rate of Regiocit will be indexed to the blood flow rate (BFR) to achieve a target blood citrate concentration of 3 to 4 mmol/L. A BFR between 100 to 180 mL/min will be advised; a lower BFR can minimize patient citrate exposure, particularly in patients with lower body weight.
Biphozyl is used as a replacement fluid during CRRT. It is injected into the extracorporeal circuit before (pre-dilution) or after (post-dilution) the filter. After the initiation of RRT, Biphozyl is used for late treatment of the acute condition when pH, potassium, and phosphate concentrations return to normal. Biphozyl can also be used if any other buffer is in use or during RCA. The volume and rate of administration of Biphozyl depend on the blood concentration of phosphate and other electrolytes, acid-base balance, body fluid balance, and overall clinical condition of the patient. The volume of replacement fluid given also depends on the expected intensity (dosage) of treatment.
Prismasol 2 is used as a replacement fluid during CRRT. It is injected into the extracorporeal circuit before (pre-dilution) or after (post-dilution) the filter. The volume and rate of administration of Prismasol 2 depend on the blood concentration of electrolytes, acid-base balance, fluid balance, and overall clinical condition of the patient. The volume of replacement fluid administered also depends on the required intensity (dosage) of the treatment.
Beijing Chao-yang Hospital, Capital Medical University
Beijing, China
RECRUITINGBeijing Anzhen Hospital, Capital Medical University
Beijing, China
RECRUITINGXuanwu Hospital Capital Medical University
Beijing, China
RECRUITINGThe First Affiliated Hospital of Chongqing Medical University
Chongqing, China
RECRUITINGThe First People's Hospital of Guangzhou
Guangzhou, China
RECRUITINGZhujiang Hospital, Southern Medical University
Guangzhou, China
RECRUITINGZhejiang Provincial People's Hospital
Hangzhou, China
RECRUITINGZhongShan Hospital Fudan University
Shanghai, China
RECRUITINGShanghai East Hospital
Shanghai, China
RECRUITINGZhongnan Hospital, Wuhan University
Wuhan, China
RECRUITINGFilter Lifespan - Duration
The duration of filter use during the use of pre-mixed solutions
Time frame: From initiation of 1st CRRT with sponsored solutions until mandatory replacement at 72 hours, death, access problems, filter or circuit clotting, filter membrane rupture, elective stopping of the filter, or achievement of treatment goals, whichever first
Filter Lifespan - Replacement or Discontinuation
The reasons for replacing or discontinuing the filter during the use of pre-mixed solutions
Time frame: From initiation of 1st CRRT with sponsored solutions until mandatory replacement at 72 hours, death, access problems, filter or circuit clotting, filter membrane rupture, elective stopping of the filter, or achievement of treatment goals, whichever first
Electrolyte and Acid-Base Indicators - Calcium
Serum ionized calcium, total calcium and post-filter ionized calcium
Time frame: Within 4 hours before the start of CRRT (baseline), 2h ± 1h, 6h ± 2h after the start of CRRT, and daily after 24h of CRRT initiation until the end of use of the pre-mixed solutions during the 1st CRRT session.
Electrolyte and Acid-Base Indicators - Potassium
Potassium
Time frame: Within 4 hours before the start of CRRT (baseline), and daily after 24h of CRRT initiation until the end of use of the pre-mixed solutions during the 1st CRRT session.
Electrolyte and Acid-Base Indicators - Sodium
Sodium
Time frame: Within 4 hours before the start of CRRT (baseline), and daily after 24h of CRRT initiation until the end of use of the pre-mixed solutions during the 1st CRRT session.
Electrolyte and Acid-Base Indicators - Phosphate
Phosphate
Time frame: Within 4 hours before the start of CRRT (baseline), and daily after 24h of CRRT initiation until the end of use of the pre-mixed solutions during the 1st CRRT session.
Electrolyte and Acid-Base Indicators - Magnesium
Magnesium
Time frame: Within 4 hours before the start of CRRT (baseline), and daily after 24h of CRRT initiation until the end of use of the pre-mixed solutions during the 1st CRRT session.
Electrolyte and Acid-Base Indicators - Bicarbonate
Bicarbonate
Time frame: Within 4 hours before the start of CRRT (baseline), and daily after 24h of CRRT initiation until the end of use of the pre-mixed solutions during the 1st CRRT session.
Electrolyte and Acid-Base Indicators - pH
Blood pH value
Time frame: Within 4 hours before the start of CRRT (baseline), and daily after 24h of CRRT initiation until the end of use of the pre-mixed solutions during the 1st CRRT session.
User experience of the pre-mixed solutions
A questionnaire about the preparation time, ease of operation, and additional workload when using the pre-mixed solutions will be provided to the investigators to collect information on user experience.
Time frame: At the end of the study, i.e., Day 30 post treatment
Severe bleeding events
1. The requirement to transfuse 400 mL of whole blood or more than 2U of red blood cell suspension/concentrated red blood cells due to bleeding in a single time. 2. Bleeding that requires reoperation 3. New-onset intracranial hemorrhage without traumatic events.
Time frame: From initiation of the 1st CRRT with sponsored solutions until Day 7 post treatment
Citrate accumulation
Defined as a total/ionized calcium ratio in serum \>2.5, with metabolic acidosis (as determined by the investigator)
Time frame: From initiation of the 1st CRRT with sponsored solutions until Day 7 post treatment
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