The issues with early continuous renal replacement therapy for National Health Insurance patients: A case report

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.

Keywords: Blood purification; Continuous renal replacement therapy; CRRT; Low-resource setting; Sepsis

Citation: Djaja AS, Adhrie Sugiarto A, Irawany V. The issues with early continuous renal replacement therapy for National Health Insurance patients: a case report. Anaesth. pain intensive care 2024;28(2):380−383; DOI: 10.35975/apic.v28i2.2417

Received: February 22, 2023; Revised: January 30, 2024; Accepted: January 31, 2024