Comparing Dialysis Modalities for Critically Ill Patients

Mehta, Ravindra L.

doi:10.2215/cjn.01330307

Cited by 4 publications

(3 citation statements)

References 20 publications

(15 reference statements)

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“…We have also provided evidence that Std Kt/V could be used as a unified dose expression to assess and compare treatment efficacy of different CRRT modalities and among different treatment frequencies, and could be used as standard method to monitor dose delivered. This is an unresolved issue as there are no established metrics for monitoring the dose delivered or ensuring the quality of renal replacement therapy we are providing to critically ill patients with AKI . Kleger and Fassler recently explored the concept of using circuit longevity as quality indicator in CRRT.…”

Section: Discussionmentioning

confidence: 99%

“…This is an unresolved issue as there are no established metrics for monitoring the dose delivered or ensuring the quality of renal replacement therapy we are providing to critically ill patients with AKI. 27 Kleger and Fassler recently explored the concept of using circuit longevity as quality indicator in CRRT. These authors showed that in addition to monitoring the complication rates of alternative anticoagulation strategies, the evaluation of circuit longevity using survival analysis (i.e., time to access or system failure) is a simple feasible means of assessing the quality of CRRT in the ICU.…”

Section: Figurementioning

confidence: 99%

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Anticoagulation, delivered dose and outcomes in CRRT: The program to improve care in acute renal disease (PICARD)

Granado

Macedo

Soroko

et al. 2014

Hemodialysis International

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Background Delivered dialysis dose by CRRT depends on circuit efficacy, which is influenced in part by the anticoagulation strategy. We evaluated the association of anticoagulation strategy used on solute clearance efficacy, circuit longevity, bleeding complications, and mortality. Methods We analyzed data from 1740 sessions 24 hours in length among 244 critically-ill patients, with at least 48 hours on CRRT. Regional citrate, heparin or saline flushes was variably used to prevent or attenuate filter clotting. We calculated delivered dose using the standardized Kt/Vurea. We monitored filter efficacy by calculating FUN/BUN ratios. Results Filter longevity was significantly higher with citrate (median 48, IQR 20.3–75.0 hours) than with heparin (5.9, IQR 8.5–27.0 hours) or no anticoagulation (17.5, IQR 9.5–32 hours, p<0.0001). Delivered dose was highest in treatments where citrate was employed. Bleeding complications were similar across the three groups (p=0.25). Compared to no anticoagulation, odds of death was higher with the heparin use (OR 1.82, 95% CI 1.02–3.32; p=0.033) but not with citrate (OR 1.02 95% CI 0.54–1.96; p = 0.53). Conclusions Relative to heparin or no anticoagulation, the use of regional citrate for anticoagulation in CRRT was associated with significantly prolonged filter life and increased filter efficacy with respect to delivered dialysis dose. Rates of bleeding complications, transfusions, and mortality were similar across the three groups. While these and other data suggest that citrate anticoagulation may offer superior technical performance than heparin or no anticoagulation, adequately powered clinical trials comparing alternative anticoagulation strategies should be performed to evaluate overall safety and efficacy.

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Section: Discussionmentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Anticoagulation, delivered dose and outcomes in CRRT: The program to improve care in acute renal disease (PICARD)

Granado

Macedo

Soroko

et al. 2014

Hemodialysis International

Self Cite

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“…Dosage adjustments to meet the changing needs should be incorporated into the trial strategy, and elements of process of care should be captured to validate the adequacy of the randomization process. 16 We anticipate that two large trials (Acute Renal Failure Trial Network [ATN] 7 and RENAL 9 ) examining the dialysis dosage-outcome relationships are due to be reported in the next few months. These trials will provide unique opportunities to assess these elements and validate the relevance of dialysis dosage in AKI.…”

mentioning

confidence: 99%