A randomized cross-over comparison of the hemodynamic response to intermittent hemodialysis and continuous hemofiltration in ICU patients with acute renal failure

1996 ◽  
Vol 22 (8) ◽  
pp. 742-746 ◽  
Author(s):  
Beno�t Misset ◽  
Jean-Fran�ois Timsit ◽  
Sylvie Chevret ◽  
Bertrand Renaud ◽  
Fabienne Tamion ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Hemodynamic Response ◽  
Intermittent Hemodialysis ◽  
Continuous Hemofiltration ◽  
Icu Patients

scholarly journals Population Pharmacokinetics of Colistin Methanesulfonate and Colistin in Critically Ill Patients with Acute Renal Failure Requiring Intermittent Hemodialysis

2016 ◽  
Vol 60 (3) ◽  
pp. 1788-1793 ◽  
Author(s):  
M. Jacobs ◽  
N. Grégoire ◽  
B. Mégarbane ◽  
P. Gobin ◽  
D. Balayn ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Published Data ◽  
Intermittent Hemodialysis ◽  
Dosing Regimen ◽  
Icu Patients ◽  
Unbound Fraction ◽  
Colistin Methanesulfonate

Colistin is increasingly used as a last option for the treatment of severe infections due to Gram-negative bacteria in critically ill patients requiring intermittent hemodialysis (HD) for acute renal failure. Our objective was to characterize the pharmacokinetics (PK) of colistin and its prodrug colistin methanesulfonate (CMS) in this population and to suggest dosing regimen recommendations. Eight intensive care unit (ICU) patients who were under intermittent HD and who were treated by CMS (Colimycine) were included. Blood samples were collected between two consecutive HD sessions. CMS and colistin concentrations were measured by a specific chromatographic assay and were analyzed using a PK population approach (Monolix software). Monte Carlo simulations were conducted to predict the probability of target attainment (PTA). CMS nonrenal clearance was increased in ICU-HD patients. Compared with that of ICU patients included in the same clinical trial but with preserved renal function, colistin exposure was increased by 3-fold in ICU-HD patients. This is probably because a greater fraction of the CMS converted into colistin. To maintain colistin plasma concentrations high enough (>3 mg/liter) for high PTA values (area under the concentration-time curve for the free, unbound fraction of a drug [fAUC]/MIC of >10 andfAUC/MIC of >50 for systemic and lung infections, respectively), at least for MICs lower than 1.5 mg/liter (nonpulmonary infection) or 0.5 mg/liter (pulmonary infection), the dosing regimen of CMS should be 1.5 million international units (MIU) twice daily on non-HD days. HD should be conducted at the end of a dosing interval, and a supplemental dose of 1.5 MIU should be administered after the HD session (i.e., total of 4.5 MIU for HD days). This study has confirmed and complemented previously published data and suggests ana prioriclear and easy to follow dosing strategy for CMS in ICU-HD patients.

scholarly journals Evaluation of intermittent hemodialysis conducted off-site on patients with renal insufficiency admitted in the intensive care unit of a developing country

2019 ◽  
Vol 7 (2) ◽  
pp. 410
Author(s):  
Aïcha Simour ◽  
Tarek Dendane ◽  
Khalid Abidi ◽  
Jihane Belayachi ◽  
Naoufel Madani ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Serum Creatinine ◽  
Intermittent Hemodialysis ◽  
Icu Mortality ◽  
Icu Patients ◽  
Hemodialysis Unit ◽  
Median Serum ◽  
Improvement In Survival

Background: In most developing countries, the renal replacement therapy (RRT) in ICU is not performed locally. We designed this study to assess the intermittent hemodialysis (IHD) offsite intakes on survival in critically ill patients admitted with renal failure.Methods: We prospectively analyzed all patients admitted to medical ICU with Acute Renal Failure (AKF) or Chronic Renal Failure (CKF) from February 2011 to September 2013. Patients were divided into two groups: those that received IHD in Hemodialysis Unit (IHD+) and those who did not (IHD-). Every patient IHD+ was matched to a patient IHD - using propensity score.Results: 202 patients were included: 151 with ARF and 51 with CRF. 116 patients were matched (age: 48±18 years; 46F/70M; median serum creatinine: 51mg/l; IQR: 32-90 mg/l). The total number of dialysis sessions was 112 for 58 patients (1.8±1.4 session/patient). The median delay to initiate IHD was 5.5h (IQR: 2-8h) and median duration of transportation was 10 min (IQR: 10-15min) with 23.6% transportation incidents. Significant hypotension with tachycardia were reported during IHD. ICU mortality rate was the same in the both groups (58.6%). In multivariate analysis, CRF (RR=2.69; p=0.006), serum creatinine >50mg/l (RR=3.54; p=0.007) and requirement for vasopressors infusion (RR=1.8; p=0.041) were independent predictive factors for receiving IHD.Conclusions: Our study doesn’t show an improvement in survival in ICU patients who receive IHD offsite. The probability to require IHD offsite increases with CRF and the use of vasopressors.

Extracorporeal Treatment Strategy in Acute Renal Failure

2002 ◽  
Vol 25 (5) ◽  
pp. 391-396 ◽  
Author(s):  
A. Jörres
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Prospective Studies ◽  
Meta Analysis ◽  
Volume Overload ◽  
Hemodynamic Instability ◽  
Renal Recovery ◽  
Intermittent Hemodialysis ◽  
Continuous Hemofiltration ◽  
Renal Replacement Therapies

The mortality of acute renal failure remains high (around 50–70%) despite manifold improvements in terms of techniques and equipment for renal replacement therapies as well as patient monitoring and intensive care support. At present, it is not clear if the method chosen for renal replacement therapy, i.e. intermittent hemodialysis or continuous hemofiltration, might impact on the outcome of these patients. Whilst earlier retrospective studies suggested that CVVH might result in better survival and renal recovery in acute patients, recent prospective studies indicated that this may not be the case or, conversely, outcomes may be better with IHD. These studies were, however, not evenly randomised in terms of illness severity or were too small to produce conclusive results. In addition, a meta-analysis of 9 published prospective studies in 692 pts. indicated a similar mortality with CVVH vs. IHD. Some of the studies enrolled for this meta-analysis, however, suffered from methodological and/or randomisation problems, thus this important question remains to date unanswered. Typically, CVVH is chosen for treating patients with hemodynamic instability and volume overload. In such cases, however, CVVH should be performed with a filtrate volume of at least 35 ml/kg body weight per hour as this was shown to be associated with better survival as compared to smaller filtrate volumes. A second controversy exists to date whether the choice of the dialyzer membrane might be of relevance for the outcome of patients with acute renal failure. Earlier studies indicated that the use of biocompatible membranes in these patients may result in improved patient survival and renal recovery. More recently, however, similar studies could not confirm these results. Another meta-analysis of controlled prospective trials (671 patients in 7 separate studies) calculated a relative mortality risk of 1.01 for cuprophan vs. biocompatible membranes. Thus, the choice of the dialyzer membrane should be based on individual assessment rather than treatment bias.

Continuous Hemodiafiltration in Children

PEDIATRICS ◽  
1990 ◽  
Vol 85 (5) ◽  
pp. 819-823
Author(s):  
Nancy A. Bishof ◽  
Thomas R. Welch ◽  
C. Frederic Strife ◽  
Frederick C. Ryckman
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Peritoneal Dialysis ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Effective Means ◽  
Tumor Lysis Syndrome ◽  
Intermittent Hemodialysis ◽  
Tumor Lysis ◽  
Continuous Arteriovenous Hemofiltration

Continuous arteriovenous hemofiltration is a form of renal replacement therapy whereby small molecular weight solutes and water are removed from the blood via convection, alleviating fluid overload and, to a degree, azotemia. It has been used in many adults and several children. However, in patients with multisystem organ dysfunction and acute renal failure, continuous arteriovenous hemofiltration alone may not be sufficient for control of azotemia; intermittent hemodialysis or peritoneal dialysis may be undesirable in such unstable patients. Recently, the technique of continuous arteriovenous hemodiafiltration has been used in many severely ill adults. We have used continuous arteriovenous hemodiafiltration in four patients at Children's Hospital Medical Center. Patient 1 suffered perinatal asphyxia and oliguria while on extracorporeal membrane oxygenation. Patients 2 and 4 both had Burkitt lymphoma and tumor lysis syndrome. Patient 3 had septic shock several months after a bone marrow transplant. All had acute renal failure and contraindications to hemodialysis or peritoneal dialysis. A blood pump was used in three of the four patients, while spontaneous arterial flow was adequate in one. Continuous arteriovenous hemodiafiltration was performed for varying lengths of time, from 11 hours to 7 days. No patient had worsening of cardiovascular status or required increased pressor support during continuous arteriovenous hemodiafiltration. The two survivors (patients 2 and 4) eventually recovered normal renal function. Continuous arteriovenous hemodiafiltration is a safe and effective means of renal replacement therapy in the critically ill child. It may be ideal for control of the metabolic and electrolyte abnormalities of the tumor lysis syndrome.

Intradialytic Complications in Dogs with Acute Renal Failure Submitted to Intermittent Hemodialysis

2017 ◽  
Vol 12 (6) ◽  
pp. 288-293
Author(s):  
Alessandra Melchert ◽  
Pasqual Barretti ◽  
Priscylla Tatiana Ch ◽  
Andre Luis Balbi ◽  
Luis Cuadrado M ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Intermittent Hemodialysis
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