Continuous renal replacement therapy for refractory intracranial hypertension?

Continuous renal replacement therapy (CRRT) is the preferred mode of renal replacement therapy in patients with acute brain injury (ABI). There are limited data available describing the effects of CRRT on intracranial pressure (ICP). This study aims to evaluate changes in ICP during CRRT in patients after ABI.

This is a retrospective observational cohort study of patients with ABI, who had ICP monitoring as part of routine management and also underwent CRRT. Hourly ICP and fluid balance, type and indication for CRRT, ICP management, and patient demographics were extracted from the medical record. Wilcoxon signed-rank test was used to evaluate changes in ICP and volume during the 12 hours before and after the initiation of CRRT.

Two patients with severe traumatic brain injury, one patient with moderate traumatic brain injury and one patient with subarachnoid hemorrhage were identified. Three patients were diagnosed with refractory intracranial hypertension (RIH) before the initiation of therapy and had a nonsignificant trend toward reduction of ICP during CRRT (p = 0.1810). One patient with chronic renal failure, who developed elevated ICP during conventional intermittent hemodialysis, demonstrated stability of ICP when switched to CRRT.

CRRT may have beneficial effects in patients with RIH. Given the high mortality rate and poor neurological outcome associated with RIH, further research may be warranted.