Intensive versus Minimal Standard Dosage for Peritoneal Dialysis in Acute Kidney Injury: A Randomized Pilot Study

Parapiboon, Watanyu; Jamratpan, Treechada

doi:10.3747/pdi.2016.00260

Cited by 26 publications

(29 citation statements)

References 20 publications

(31 reference statements)

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“…vancomycin in patients with AKI treated by HVPD (prescribed Kt/V of 0.5 per session). However, recent studies have presented similar outcomes of patients with AKI treated with lower PD doses 34, 35. Parapiboon et al.…”

Section: Discussionmentioning

confidence: 87%

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Vancomycin Removal During High-Volume Peritoneal Dialysis in Acute Kidney Injury Patients: A Prospective Cohort Clinical Study

Ponce

Zamoner

Freitas

et al. 2019

Kidney International Reports

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IntroductionVancomycin pharmacokinetic data in patients with acute kidney injury (AKI) on high-volume peritoneal dialysis (HVPD) are lacking. The aims were to study the pharmacokinetics of i.v. vancomycin in patients with AKI treated by HVPD who received an i.v. dose of vancomycin (15–20 mg/kg), to determine the vancomycin removal, and to establish vancomycin dosing and evaluation pharmacokinetics target attainment achievement for the empirical treatment of patients with AKI treated by HVPD.MethodsVancomycin was administered 1 hour before dialysis start. Samples of all dialysate were collected for a 24-hour period. Blood samples were collected after 1, 2, 4, and 24 hours of therapy. Vancomycin concentrations were determined using a liquid chromatographic (high-performance liquid chromatography)–fluorescence method. Pharmacokinetic calculations were completed assuming a 1-compartment model.ResultsTen patients completed the study. The mean vancomycin dose administered was 18.0 ± 2.95 mg/kg (14.7–21.8 mg/kg) on the day of study (first day) and the mean percentage of vancomycin removal by HVPD was 21.7% ± 2.2% (16%–29%). Peritoneal clearance was 8.1 ± 2.2 ml/min (5.3–12 ml/min). The serum vancomycin half-life was 71.2 ± 24.7 hours (42–110 hours) during HVPD session, the maximum serum concentration was 26.2 ± 3.5 mg/l, which occurred 1 hour after vancomycin administration and HVPD start. Area under the curve (AUC)0–24/minimum inhibitory concentration (MIC) ratio ≥400 was achieved in all patients when MIC = 1 mg/l was considered.ConclusionHVPD removes considerable amounts of vancomycin in septic patients with AKI. Administration of 18 mg/kg vancomycin each 48 to 72 hours in patients with AKI undergoing HVPD was required to reach and maintain therapeutic concentrations.

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Section: Discussionmentioning

confidence: 87%

“…Parapiboon et al. 35 presented a study using PD to treat 80 critically ill patients with AKI. This was a randomized controlled trial comparing the 2 regimens recommended in the International Society for Peritoneal Dialysis guidelines, aimed at achieving target weekly Kt/V of 3.5 and 2.1, respectively 33 .…”

Section: Discussionmentioning

confidence: 99%

Vancomycin Removal During High-Volume Peritoneal Dialysis in Acute Kidney Injury Patients: A Prospective Cohort Clinical Study

Ponce

Zamoner

Freitas

et al. 2019

Kidney International Reports

View full text Add to dashboard Cite

show abstract

“…19 The study by Parapiboon and Jamratpan noted that achieving a Kt/V urea of 2.26 provided comparable results to a Kt/V urea of 3.3 for the first 2 days of treatment, with adjustments in dialysis prescription thereafter based on clinical and laboratory findings. 12 Targets above 3.5/ week did not improve patient survival. 1 The prescriber may choose to target an initial Kt/V urea between 2.1/week and 3.5/week, depending on the clinical circumstances and make appropriate adjustments as clinically indicated.…”

Section: Discussionmentioning

confidence: 95%

“…Most studies on acute PD did not describe how the dose was calculated. 9,10,12,[18][19][20] Instead, a predetermined dialysate volume was most frequently employed in the study protocol.…”

Section: Reported Methods Of Prescribing To a Target Dosementioning

confidence: 99%

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Peritoneal dialysis for acute kidney injury: Equations for dosing in pandemics, disasters, and beyond

2020

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Background: Peritoneal dialysis (PD) is a viable option for renal replacement therapy in acute kidney injury (AKI), especially in challenging times during disasters and pandemics when resources are limited. While PD techniques are well described, there is uncertainty about how to determine the amount of PD to be prescribed toward a target dose. The aim of this study is to derive practical equations to assist with the prescription of PD for AKI. Methods: Using established physiological principles behind PD clearance and membrane transport, a primary determinant of dose delivery, equations were mathematically derived to estimate dialysate volume required to achieve a target dose of PD. Results: The main derivative equation is VD = (1.2 × std- Kt/ V × TBW)/( t dwell + 4), where VD is the total dialysate volume per day, std- Kt/ V is the desired weekly dose, TBW is the total body water, and t dwell is the dwell time. VD can be expressed in terms of dwell volume, v dwell, by VD = (0.3 × std- Kt/ V × TBW) − (6 × v dwell). Two further equations were derived which directly describe the mathematical relationship between t dwell and v dwell. A calculator is included as an Online Supplementary Material. Conclusions: The equations are intended as a practical tool to estimate solute clearances and guide prescription of continuous PD. The estimated dialysate volume required for any dose target can be calculated from cycle duration or dwell volume. However, the exact target dose of PD is uncertain and should be adjusted according to the clinical circumstances and response to treatment. The equations presented in this article facilitate the adjustment of PD prescription toward the targeted solute clearance.

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Peritoneal Dialysis in Acute Kidney Injury: Prescribing Acute PD

Ponce

Balbi

2021

Applied Peritoneal Dialysis

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Intensive versus Minimal Standard Dosage for Peritoneal Dialysis in Acute Kidney Injury: A Randomized Pilot Study

Abstract: Among AKI patients who required PD, there was no significant difference in in-hospital mortality between intensive and minimal standard PD dosage.

Cited by 26 publications

References 20 publications

Vancomycin Removal During High-Volume Peritoneal Dialysis in Acute Kidney Injury Patients: A Prospective Cohort Clinical Study

Vancomycin Removal During High-Volume Peritoneal Dialysis in Acute Kidney Injury Patients: A Prospective Cohort Clinical Study

Peritoneal dialysis for acute kidney injury: Equations for dosing in pandemics, disasters, and beyond

Peritoneal Dialysis in Acute Kidney Injury: Prescribing Acute PD

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