Innovation and development of continuous renal replacement equipment_West China Medical Journal

Authors：

SHENG Xiaohua ¹ , YING Zidong ¹ , YU Gang ¹ , ZHAO Liping ¹ , PENG Yanfang ² ,  WANG Niansong ¹

1. Department of Nephrology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, P. R. China;
2. SWS Hemodialysis Care Co., LTD, Chongqing 401123, P. R. China;

Corresponding author：

WANG Niansong, Email: wangniansong2012@163.com

Keywords：

Continuous renal replacement therapy; equipment; innovation

DOI：

10.7507/1002-0179.202408072

Video：

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Continuous renal replacement therapy (CRRT) originated from intermittent hemodialysis. Over the past 40 years, its application scope has gradually expanded from the initial treatment of kidney diseases alone to the support of multi-organ functions. As a safe, adequate, and flexible therapeutic modality, CRRT has become one of the main means of treating critically ill patients. Continuous innovation in technology, biomaterials and other technologies provides important driving force for the sustainable development of CRRT. This paper reviews the technological innovation and development of CRRT devices. With continuous technological updates and iteration, CRRT can better adapt to clinical needs. Biofeedback, portability, and intelligence are several directions of the development of CRRT, which can provide more accurate and personalized treatment for critically ill patients in different scenarios.

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2.	邬步云, 余燕婷, 季大玺. 连续性肾脏替代治疗在中国的发展历程与展望. 中国血液净化, 2019, 18(9): 587-590.
3.	Ricci Z, Romagnoli S, Ronco C, et al. From continuous renal replacement therapies to multiple organ support therapy. Contrib Nephrol, 2018, 194: 155-169.
4.	Husain-Syed F, Ricci Z, Brodie D, et al. Extracorporeal organ support (ECOS) in critical illness and acute kidney injury: from native to artificial organ crosstalk. Intensive Care Med, 2018, 44(9): 1447-1459.
5.	Kramer P, Wigger W, Rieger J, et al. Arteriovenous haemofiltration: a new and simple method for treatment of over-hydrated patients resistant to diuretics. Klin Wochenschr, 1977, 55(22): 1121-1122.
6.	See E, Ronco C, Bellomo R. The future of continuous renal replacement therapy. Semin Dial, 2021, 34(6): 576-585.
7.	Ronco C, Fabris A, Feriani M, et al. Technical and clinical evaluation of a new system for ultrafiltration control during hemodialysis. ASAIO Trans, 1988, 34(3): 613-616.
8.	Ricci Z, Bonello M, Salvatori G, et al. Continuous renal replacement technology: from adaptive devices to flexible multipurpose machines. Crit Care Resusc, 2004, 6(3): 180-187.
9.	Bellomo R, Ronco C. Continuous haemofiltration in the intensive care unit. Crit Care, 2000, 4(6): 339-345.
10.	Clark WR, Villa G, Neri M, et al. Advances in machine technology. Contrib Nephrol, 2018, 194: 80-89.
11.	Ricci Z, Bonello M, Salvatori G, et al. Continuous renal replacement technology: from adaptive technology and early dedicated machines towards flexible multipurpose machine platforms. Blood Purif, 2004, 22(3): 269-276.
12.	Ricci Z, Salvatori G, Bonello M, et al. A new machine for continuous renal replacement therapy: from development to clinical testing. Expert Rev Med Devices, 2005, 2(1): 47-55.
13.	Ronco C. Evolution of technology for continuous renal replacement therapy: forty years of improvements. Contrib Nephrol, 2017, 189: 114-123.
14.	Lorenzin A, Garzotto F, Alghisi A, et al. CVVHD treatment with CARPEDIEM: small solute clearance at different blood and dialysate flows with three different surface area filter configurations. Pediatr Nephrol, 2016, 31(10): 1659-1665.
15.	Parolin M, Ceschia G, Vidal E. New perspectives in pediatric dialysis technologies: the case for neonates and infants with acute kidney injury. Pediatr Nephrol, 2024, 39(1): 115-123.
16.	Kellum JA, Ronco C. The 17th Acute Disease Quality Initiative International Consensus Conference: introducing precision renal replacement therapy. Blood Purif, 2016, 42(3): 221-223.
17.	Broman M, Bell M, Joannes-Boyau O, et al. The novel prismax continuous renal replacement therapy system in a multinational, multicentre pilot setting. Blood Purif, 2018, 46(3): 220-227.
18.	Schmidt M, Hodgson C, Combes A. Extracorporeal gas exchange for acute respiratory failure in adult patients: a systematic review. Crit Care, 2015, 19(1): 99.
19.	Ronco C, Reis T. Continuous renal replacement therapy and extended indications. Semin Dial, 2021, 34(6): 550-560.
20.	Costanzo MR, Ronco C, Abraham WT, et al. Extracorporeal ultrafiltration for fluid overload in heart failure: current status and prospects for further research. J Am Coll Cardiol, 2017, 69(19): 2428-2445.
21.	Bisht H, Tripathi A, Arya A, et al. Ultrafiltration in heart failure: a review. Cureus, 2023, 15(6): e39933.
22.	García Martínez JJ, Bendjelid K. Artificial liver support systems: what is new over the last decade?. Ann Intensive Care, 2018, 8(1): 109.
23.	Godet T, Combes A, Zogheib E, et al. Novel CO₂ removal device driven by a renal-replacement system without hemofilter. A first step experimental validation. Anaesth Crit Care Pain Med, 2015, 34(3): 135-140.
24.	Cove ME, MacLaren G, Federspiel WJ, et al. Bench to bedside review: extracorporeal carbon dioxide removal, past present and future. Crit Care, 2012, 16(5): 232.
25.	Romagnoli S, Ricci Z, Ronco C. Novel extracorporeal therapies for combined renal-pulmonary dysfunction. Semin Nephrol, 2016, 36(1): 71-77.
26.	赵宇亮, 韦伟, 张凌, 等. 连续性肾脏替代治疗的信息化及人工智能. 华西医学, 2022, 37(7): 1066-1069.
27.	Hammouda N, Neyra JA. Can artificial intelligence assist in delivering continuous renal replacement therapy?. Adv Chronic Kidney Dis, 2022, 29(5): 439-449.
28.	Szamosfalvi B, Heung M, Yessayan L. Technology innovations in continuous kidney replacement therapy: the clinician’s perspective. Adv Chronic Kidney Dis, 2021, 28(1): 3-12.
29.	周春华, 唐文宏, 李平, 等. 一种新型的血液净化设备——便携式连续性血液净化机的研制. 生物医学工程研究, 2010, 29(3): 215-218.

1. Samoni S, Husain-Syed F, Villa G, et al. Continuous renal replacement therapy in the critically ill patient: from garage technology to artificial intelligence. J Clin Med, 2021, 11(1): 172.
2. 邬步云, 余燕婷, 季大玺. 连续性肾脏替代治疗在中国的发展历程与展望. 中国血液净化, 2019, 18(9): 587-590.
3. Ricci Z, Romagnoli S, Ronco C, et al. From continuous renal replacement therapies to multiple organ support therapy. Contrib Nephrol, 2018, 194: 155-169.
4. Husain-Syed F, Ricci Z, Brodie D, et al. Extracorporeal organ support (ECOS) in critical illness and acute kidney injury: from native to artificial organ crosstalk. Intensive Care Med, 2018, 44(9): 1447-1459.
5. Kramer P, Wigger W, Rieger J, et al. Arteriovenous haemofiltration: a new and simple method for treatment of over-hydrated patients resistant to diuretics. Klin Wochenschr, 1977, 55(22): 1121-1122.
6. See E, Ronco C, Bellomo R. The future of continuous renal replacement therapy. Semin Dial, 2021, 34(6): 576-585.
7. Ronco C, Fabris A, Feriani M, et al. Technical and clinical evaluation of a new system for ultrafiltration control during hemodialysis. ASAIO Trans, 1988, 34(3): 613-616.
8. Ricci Z, Bonello M, Salvatori G, et al. Continuous renal replacement technology: from adaptive devices to flexible multipurpose machines. Crit Care Resusc, 2004, 6(3): 180-187.
9. Bellomo R, Ronco C. Continuous haemofiltration in the intensive care unit. Crit Care, 2000, 4(6): 339-345.
10. Clark WR, Villa G, Neri M, et al. Advances in machine technology. Contrib Nephrol, 2018, 194: 80-89.
11. Ricci Z, Bonello M, Salvatori G, et al. Continuous renal replacement technology: from adaptive technology and early dedicated machines towards flexible multipurpose machine platforms. Blood Purif, 2004, 22(3): 269-276.
12. Ricci Z, Salvatori G, Bonello M, et al. A new machine for continuous renal replacement therapy: from development to clinical testing. Expert Rev Med Devices, 2005, 2(1): 47-55.
13. Ronco C. Evolution of technology for continuous renal replacement therapy: forty years of improvements. Contrib Nephrol, 2017, 189: 114-123.
14. Lorenzin A, Garzotto F, Alghisi A, et al. CVVHD treatment with CARPEDIEM: small solute clearance at different blood and dialysate flows with three different surface area filter configurations. Pediatr Nephrol, 2016, 31(10): 1659-1665.
15. Parolin M, Ceschia G, Vidal E. New perspectives in pediatric dialysis technologies: the case for neonates and infants with acute kidney injury. Pediatr Nephrol, 2024, 39(1): 115-123.
16. Kellum JA, Ronco C. The 17th Acute Disease Quality Initiative International Consensus Conference: introducing precision renal replacement therapy. Blood Purif, 2016, 42(3): 221-223.
17. Broman M, Bell M, Joannes-Boyau O, et al. The novel prismax continuous renal replacement therapy system in a multinational, multicentre pilot setting. Blood Purif, 2018, 46(3): 220-227.
18. Schmidt M, Hodgson C, Combes A. Extracorporeal gas exchange for acute respiratory failure in adult patients: a systematic review. Crit Care, 2015, 19(1): 99.
19. Ronco C, Reis T. Continuous renal replacement therapy and extended indications. Semin Dial, 2021, 34(6): 550-560.
20. Costanzo MR, Ronco C, Abraham WT, et al. Extracorporeal ultrafiltration for fluid overload in heart failure: current status and prospects for further research. J Am Coll Cardiol, 2017, 69(19): 2428-2445.
21. Bisht H, Tripathi A, Arya A, et al. Ultrafiltration in heart failure: a review. Cureus, 2023, 15(6): e39933.
22. García Martínez JJ, Bendjelid K. Artificial liver support systems: what is new over the last decade?. Ann Intensive Care, 2018, 8(1): 109.
23. Godet T, Combes A, Zogheib E, et al. Novel CO₂ removal device driven by a renal-replacement system without hemofilter. A first step experimental validation. Anaesth Crit Care Pain Med, 2015, 34(3): 135-140.
24. Cove ME, MacLaren G, Federspiel WJ, et al. Bench to bedside review: extracorporeal carbon dioxide removal, past present and future. Crit Care, 2012, 16(5): 232.
25. Romagnoli S, Ricci Z, Ronco C. Novel extracorporeal therapies for combined renal-pulmonary dysfunction. Semin Nephrol, 2016, 36(1): 71-77.
26. 赵宇亮, 韦伟, 张凌, 等. 连续性肾脏替代治疗的信息化及人工智能. 华西医学, 2022, 37(7): 1066-1069.
27. Hammouda N, Neyra JA. Can artificial intelligence assist in delivering continuous renal replacement therapy?. Adv Chronic Kidney Dis, 2022, 29(5): 439-449.
28. Szamosfalvi B, Heung M, Yessayan L. Technology innovations in continuous kidney replacement therapy: the clinician’s perspective. Adv Chronic Kidney Dis, 2021, 28(1): 3-12.
29. 周春华, 唐文宏, 李平, 等. 一种新型的血液净化设备——便携式连续性血液净化机的研制. 生物医学工程研究, 2010, 29(3): 215-218.

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