Measurement of the delivery of dialysis in acute renal failure

Evanson, James; İkizler, T. Alp; Wingard, Rebecca L.; Knights, Stephanie; Shyr, Yu; Schulman, Gerald; Himmelfarb, Jonathan; Hakim, Raymond M.

doi:10.1046/j.1523-1755.1999.00355.x

Cited by 85 publications

(64 citation statements)

References 23 publications

(6 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The adequacy of the dialysis dose in AKI is a subject of controversy for many reasons (15)(16)(17)(18). hourly effluent flow was increased from 25 mL/kg to 35 mL/kg or 45 mL/kg.…”

Section: Discussionmentioning

confidence: 99%

Different prescribed doses of high volume peritoneal dialysis and outcome of patients with acute kidney injury

Ponce

Brito²,

Abrão³

et al. 2012

http://isrctn.org/>

View full text Add to dashboard Cite

show abstract

“…The adequacy of the dialysis dose in AKI is a subject of controversy for many reasons (15)(16)(17)(18). hourly effluent flow was increased from 25 mL/kg to 35 mL/kg or 45 mL/kg.…”

Section: Discussionmentioning

confidence: 99%

Different prescribed doses of high volume peritoneal dialysis and outcome of patients with acute kidney injury

Ponce

Brito²,

Abrão³

et al. 2012

http://isrctn.org/>

View full text Add to dashboard Cite

show abstract

“…tients with ESRD, the clearance of urea adjusted for the volume of distribution of water has been used an index of dialysis adequacy (Kt/V urea ) (23,24). Although widely used for patients on maintenance dialysis, the use of Kt/ V urea in AKI is an area of ongoing debate (25)(26)(27)(28). Some of the key issues in this debate have stemmed from the difficulty in comparing clearance parameters across therapies (29).…”

Section: Discussionmentioning

confidence: 99%

Effluent Volume in Continuous Renal Replacement Therapy Overestimates the Delivered Dose of Dialysis

Granado¹,

Macedo²,

Chertow³

et al. 2011

Clinical Journal of the American Society of Nephrology

Self Cite

101

View full text Add to dashboard Cite

SummaryBackground and objectives Studies examining dose of continuous renal replacement therapy (CRRT) and outcomes have yielded conflicting results. Most studies considered the prescribed dose as the effluent rate represented by ml/kg per hour and reported this volume as a surrogate of solute removal. Because filter fouling can reduce the efficacy of solute clearance, the actual delivered dose may be substantially lower than the observed effluent rate.Design, setting, participants, & measurements Data were examined from 52 critically ill patients with acute kidney injury (AKI) requiring dialysis. All patients were treated with predilution continuous venovenous hemodiafiltration (CVVHDF) and regional citrate anticoagulation. Filter performance was monitored during the entire course of therapy by measuring blood urea nitrogen (BUN) and dialysis fluid urea nitrogen (FUN) at initiation and every 12 hours. Filter efficacy was assessed by calculating FUN/BUN ratios every 12 hours of filter use. Prescribed urea clearance (K, ml/min) was determined from the effluent rate. Actual delivered urea clearance was determined using dialysis-side measurements.Results Median daily treatment time was 1413 minutes (1260 to 1440) with a total effluent volume of 46.4 Ϯ 17.4 L and urea mass removal of 13.0 Ϯ 7.6 mg/min. Prescribed clearance overestimated the actual delivered clearance by 23.8%. This gap between prescribed and delivered clearance was related to the decrease in filter function assessed by the FUN/BUN ratio.Conclusions Effluent volume significantly overestimates delivered dose of small solutes in CRRT. To assess adequacy of CRRT, solute clearance should be measured rather than estimated by the effluent volume.

show abstract

“…In addition, although studies to evaluate the optimal delivered dosage per treatment in AKI have not been conducted, expert consensus has recommended a minimum Kt/ V urea of at least 1.2 delivered three times per week in this population (8). The absence of assessment of the actual delivered dosage of therapy is also notable in light of studies that documented large discrepancies between the prescribed and the delivered dosage of dialysis in this population (5,9,10).…”

Section: Discussionmentioning

confidence: 99%

Management of Renal Replacement Therapy in Acute Kidney Injury

Overberger¹,

Pesacreta

Palevsky

et al. 2007

Clinical Journal of the American Society of Nephrology

107

View full text Add to dashboard Cite

Background: Data on current practices for management of renal replacement therapy (RRT) in acute kidney injury (AKI) are limited, particularly with regard to the dosing of therapy.Design, setting, participants, and measurements: A survey was conducted of practitioners at the 27 study sites that participate in the Veterans Affairs/National Institutes of Health Acute Renal Trial Network (ATN) Study before initiation of patient enrollment for ascertainment of the local prevailing practices for management of RRT in critically ill patients with AKI. Surveys were returned from 130 practitioners at 26 of 27 study sites; the remaining study site provided aggregate data.Results: Intermittent hemodialysis and continuous RRT were the most commonly used modalities of RRT, with sustained low-efficiency dialysis and other "hybrid" treatments used in fewer than 10% of patients. Intermittent hemodialysis was most commonly provided on a thrice-weekly or every-other-day schedule, with only infrequent assessment of the delivered dosage of therapy. Most practitioners reported that they did not dose continuous RRT on the basis of patient weight. The average prescribed dosage of therapy corresponded to a weight-based dosage of no more than 20 to 25 ml/kg per h.Conclusions: These results provide insight into clinical management of RRT and provide normative data for evaluation of the design of ongoing clinical trials.

show abstract

Measurement of the delivery of dialysis in acute renal failure

Abstract: Blood-based kinetics used to estimate the dose of dialysis in ARF patients on intermittent hemodialysis provide internally consistent results. However, when compared with dialysate-side kinetics, blood-based kinetics substantially overestimated the amount of solute (urea) removal.

Cited by 85 publications

References 23 publications

Different prescribed doses of high volume peritoneal dialysis and outcome of patients with acute kidney injury

Different prescribed doses of high volume peritoneal dialysis and outcome of patients with acute kidney injury

Effluent Volume in Continuous Renal Replacement Therapy Overestimates the Delivered Dose of Dialysis

Management of Renal Replacement Therapy in Acute Kidney Injury

Contact Info

Product

Resources

About