From the Guidelines
Anakinra should not be recommended for patients undergoing Continuous Renal Replacement Therapy (CRRT) based on the provided evidence, as there is no mention of its use in this context. The surviving sepsis campaign guidelines from 2016, as reported in the study published in Intensive Care Medicine in 2017 1, focus on the management of sepsis and septic shock, including recommendations for renal replacement therapy, but do not address the role of Anakinra in patients undergoing CRRT.
Key Considerations
- The guidelines suggest using either continuous or intermittent renal replacement therapy in patients with sepsis and acute kidney injury, with a weak recommendation and moderate quality of evidence 1.
- They also recommend using continuous therapies to facilitate management of fluid balance in hemodynamically unstable septic patients, although this is based on very low quality of evidence 1.
- However, there is no direct evidence provided regarding the use of Anakinra in patients undergoing CRRT, making it difficult to recommend its use in this context.
Clinical Implications
- In clinical practice, the decision to use Anakinra in patients undergoing CRRT would need to be made on a case-by-case basis, taking into account the patient's individual circumstances and the potential risks and benefits of treatment.
- Given the lack of evidence supporting the use of Anakinra in this context, caution should be exercised and alternative treatments considered.
- It is essential to prioritize the patient's morbidity, mortality, and quality of life when making treatment decisions, and to carefully weigh the potential benefits of Anakinra against its potential risks in patients undergoing CRRT.
From the Research
Role of Anakinra in CRRT
- Anakinra, an interleukin-1 receptor antagonist, is predominantly cleared renally in humans, with its plasma clearance decreasing with decreasing renal function 2.
- The dialysis process has a minimal effect on the removal of anakinra, with less than 2.5% of the dose administered being removed by dialysis 2.
- In patients with severe renal impairment or end-stage renal disease, a dose or schedule adjustment of anakinra may be indicated due to reduced clearance 2.
CRRT Overview
- Continuous Renal Replacement Therapy (CRRT) is commonly used to provide renal support for critically ill patients with acute kidney injury, particularly those who are hemodynamically unstable 3.
- CRRT aims to remove excess fluid and solutes retained as a consequence of acute kidney injury, with various modalities available, including continuous venovenous hemofiltration, continuous venovenous hemodialysis, and continuous venovenous hemodiafiltration 3, 4.
- The management of CRRT requires a comprehensive understanding of the mechanisms of solute and fluid removal, including ultrafiltration, diffusion, convection, and adsorption 4.
Anakinra in CRRT Patients
- There is limited direct evidence on the role of anakinra in patients undergoing CRRT, but its reduced clearance in patients with renal impairment suggests that dose adjustments may be necessary in this population 2.
- The use of anakinra in CRRT patients may require careful consideration of its pharmacokinetics and potential interactions with the CRRT process, as well as close monitoring of the patient's condition 2, 3.