Intermittent Hemodialysis for Renal Replacement Therapy in Intensive Care: New Evidence for Old Truths

2007 ◽  
pp. 304-308 ◽  
Author(s):  
W. Van Biesen ◽  
N. Veys ◽  
R. Vanholder
Keyword(s):  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Intermittent Hemodialysis ◽  
New Evidence

Accelerated Venovenous Hemofiltration as a Transitional Renal Replacement Therapy in the Intensive Care Unit

2020 ◽  
Vol 51 (4) ◽  
pp. 318-326 ◽  
Author(s):  
Andrew S. Allegretti ◽  
Paul Endres ◽  
Tyler Parris ◽  
Sophia Zhao ◽  
Megan May ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Length Of Stay ◽  
Replacement Therapy ◽  
Treatment Time ◽  
Tertiary Care ◽  
Hospital Length Of Stay ◽  
Intermittent Hemodialysis ◽  
Readmission Rates

Background: Continuous renal replacement therapy (CRRT) is commonly employed in the intensive care unit (ICU), though there are no guidelines around the transition between CRRT and intermittent hemodialysis (iHD). Accelerated venovenous hemofiltration (AVVH) is a modality utilizing higher hemofiltration rates (4–5 L/h) with shorter session durations (8–10 h) to “accelerate” the clearance and volume removal that normally is spread out over a 24-h period in CRRT. We examined AVVH as a transition therapy between CRRT and iHD, with the aim of decreasing time on CRRT and providing a more graduated transition for hemodynamically unstable patients requiring RRT. Methods: Retrospective cohort study describing the clinical outcomes and quality initiative experience of the integration of AVVH into the CRRT program at an academic tertiary care center. Outcomes of interest included mortality, ICU length of stay and readmission rates, and technical characteristics of treatments. Results: In total, 97 patients received a total of 298 AVVH treatments (3.1 ± 3.3 treatments per patient). Totally, 271/298 (91%) treatments were completed successfully. During an average treatment time of 9.5 ± 1.6 h with 4.2 ± 0.5 L/h ­replacement fluid rate, urea reduction ratio was 23 ± 26% per 10-h treatment, and net ultrafiltration volume was 2.4 ± 1.3 L/treatment. Inpatient mortality was 32%, mean total hospital length of stay was 54 ± 47 days. Sixty-four out of 97 (66%) patients recovered renal function by discharge. Among those who transferred out of the ICU, 7/62 (11%) patients required readmission to the ICU after developing hypotension on iHD. Conclusion: AVVH can serve as a transition therapy between CRRT and iHD in the ICU and has the potential to decrease total time on CRRT, improve patient mobility, and sustain low ICU readmission rates. Future study is needed to analyze the implications on resource use and cost of this modality.

scholarly journals Renal Replacement Therapy in Intensive Care Unit at a Tertiary Care Center in Nepal

2019 ◽  
Vol 21 (1) ◽  
pp. 74-79
Author(s):  
Pramod Kumar Chhetri ◽  
DN Manandhar ◽  
P Poudel ◽  
S Baidya ◽  
SB Raju ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Hospital Mortality ◽  
Replacement Therapy ◽  
Care Center ◽  
Tertiary Care ◽  
Intermittent Hemodialysis ◽  
Low Efficiency

 Acute kidney injury is a major complication in intensive care unit patients. It is associated with increased in-hospital mortality and length of stay. The provision of renal replacement therapy in intensive care is not widely available in resource poor countries like Nepal. The study aims to look into clinical profile and outcome of patients who received renal replacement therapy in intensive care unit. It was an observational study done from 1st October 2016 till 30th September 2017. Patient’s demographic data, indications, biochemical tests, outcomes, modality of renal replacement therapy were recorded. Statistical package for the social sciences version 17 was used for statistical analysis. There were total of 649 admissions in intensive care, among which 148 had kidney related complications. Of 148 patients, 69 (47%) received renal replacement therapy. Mean age, urea and creatinine on admission were 50.17 ± 18.42 years, 174.54 ± 63.46 mg/dl and 8.05 ± 3.49 mg/ dl respectively. They underwent 4.32 ± 3.09 sessions and 14.94 ± 10.88 hours of renal replacement therapy. Total 42 (61%) had septic shock on admission and underwent sustained low efficiency dialysis as the modality of renal replacement therapy. In-hospital mortality was 19 (28%). Presence of septic shock on admission and mean number of ionotropes required 2.05 ± 1.12 was statistically significant for in-hospital mortality (p=0.01). About half of the patients were on mechanical ventilation which was statistically significant for in-hospital mortality (p<0.001). Sustained low efficiency dialysis can be done in patients on ionotropes and patients can be switched over to intermittent hemodialysis.

Continuous Renal Replacement Therapy for Critically Ill Patients: An Update

1994 ◽  
Vol 9 (6) ◽  
pp. 265-280 ◽  
Author(s):  
Eric F. H. van Bommel ◽  
Karel M. L. Leunissen ◽  
Willem Weimar
Keyword(s):  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Clinical Aspects ◽  
Intermittent Hemodialysis ◽  
Organ Systems

van Bommel EFH, Leunissen KML, Weimar W. Continuous renal replacement therapy for critically ill patients: an update. J Intensive Care Med 1994; 9: 265–280. Despite continuous progress in intensive care during the last decades, the outcome of critically ill patients in whom acute renal failure (ARF) develops is still poor. This outcome may be explained partially by the frequent occurrence of ARF as part of multiple organ systems failure (MOSF). In this complex and unstable patient population, the provision of adequate renal support with either intermittent hemodialysis or peritoneal dialysis may pose major problems. Continuous renal replacement therapy (CRRT) is now increasingly accepted as the preferred treatment modality in the management of ARF in these patients. The technique offers adequate control of biochemistry and fluid balance in hemodynamically unstable patients, thereby enabling aggressive nutritional and inotropic support without the risk of exacerbating azotemia or fluid overload. In addition, experimental and clinical data suggest that CRRT may have a beneficial influence on hemodynamics and gas exchange in patients with septic shock and (nonrenal) MOSF, independent of an impact on fluid balance. We review both technical and clinical aspects of various continuous therapies, including their impact on serum drug levels and nutrient balance. In addition, an attempt is made to clarify the possible beneficial role of CRRT in reducing patient morbidity and mortality in the ICU.

scholarly journals Clinical Characteristics and 30-Day Outcomes of Intermittent Hemodialysis for Acute Kidney Injury in an African Intensive Care Unit

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Arthur Kwizera ◽  
Janat Tumukunde ◽  
Lameck Ssemogerere ◽  
Emmanuel Ayebale ◽  
Peter Agaba ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Low Income ◽  
Clinical Characteristics ◽  
Kidney Injury ◽  
Intermittent Hemodialysis

Introduction. Acute kidney injury (AKI) is a common occurrence in the intensive care unit (ICU). Studies have looked at outcomes of renal replacement therapy using intermittent haemodialysis (IHD) in ICUs with varying results. Little is known about the outcomes of using IHD in resource-limited settings where continuous renal replacement therapy (CRRT) is limited. We sought to determine outcomes of IHD among critically ill patients admitted to a low-income country ICU.Methods. A retrospective review of patient records was conducted. Patients admitted to the ICU who underwent IHD for AKI were included in the study. Patients’ demographic and clinical characteristics, cause of AKI, laboratory parameters, haemodialysis characteristics, and survival were interpreted and analyzed. Primary outcome was mortality.Results. Of 62 patients, 40 had complete records. Median age of patients was 38.5 years. Etiologic diagnoses associated with AKI included sepsis, malaria, and ARDS. Mortality was 52.5%. APACHE II (OR 4.550; 95% CI 1.2–17.5,p=0.028), mechanical ventilation (OR 13.063; 95% CI 2.3–72,p=0.003), and need for vasopressors (OR 16.8; 95% CI 3.4–82.6,p=0.001) had statistically significant association with mortality.Conclusion. IHD may be a feasible alternative for RRT in critically ill haemodynamically stable patients in low resource settings where CRRT may not be available.

scholarly journals What Is the Renal Replacement Method of First Choice for Intensive Care Patients?

2001 ◽  
Vol 12 (suppl 1) ◽  
pp. S40-S43
Author(s):  
RAYMOND VANHOLDER ◽  
WIM VAN BIESEN ◽  
NORBERT LAMEIRE
Keyword(s):  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Care Patient ◽  
Intermittent Hemodialysis ◽  
Intensive Care Patients ◽  
Replacement Method ◽  
First Choice ◽  
Daily Dialysis ◽  
Dialysis Membranes

Abstract.Renal replacement therapy for the patient with acute renal failure on the intensive care unit can be offered in several different formats: intermittent hemodialysis (IHD), continuous renal replacement therapy (CRRT), and slow low-efficient daily dialysis (SLEDD). It is frequently claimed that CRRT offers several advantages over IHD, but most of these, such as correction of metabolic acidosis, better recovery of renal function, better clinical outcome due to application of biocompatible dialysis membranes, correction of malnutrition, and better removal of cytokines, are not corroborated by the results of controlled prospective studies. There is also no evidence that CRRT results in a better surival, compared with IHD. The only potential advantages of CRRT that stood the test of clinical evaluation (hemodynamic stability, correction of hypervolemia, better solute removal) can be offered as well by SLEDD. In addition, the latter strategy is less expensive because the same infrastructure is used as for IHD, while the patient is not immobilized continuously, which leaves time free for other activities such as nursing care and technical investigations. SLEDD is a relatively young technique, so thorough clinical studies are lacking. Nevertheless, the hypothesis is proposed that SLEDD offers a valuable alternative to the classical dialysis strategies, applied in the intensive care patient.

scholarly journals The Landscape of Renal Replacement Therapy in Veterans Affairs Medical Center Intensive Care Units

2020 ◽  
Author(s):  
Chandan Vangala ◽  
Maulin Shah ◽  
Natasha N. Dave ◽  
Layth Al Attar ◽  
Sankar D. Navaneethan ◽  
...  
Keyword(s):  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Medical Center ◽  
Medication Management ◽  
Quality Parameters ◽  
Intermittent Hemodialysis ◽  
Renal Replacement Therapies ◽  
Medical Facilities

Abstract Background Outpatient dialysis is standardized with several evidence-based measures of adequacy and quality that providers aim to meet while providing treatment. By contrast, in the intensive care unit (ICU) there are different types of continuous and prolonged renal replacement therapies with numerous and varied strategies for addressing patient care and a dearth of nationally accepted quality parameters. In order to eventually understand what quality measures are appropriate for ICU-related renal replacement therapy (RRT), we first aimed to capture the variety and prevalence of basic strategies and equipment utilized in the ICUs of Veteran Affairs (VA) medical facilities with inpatient hemodialysis capabilities.Methods Via email to the dialysis directors of all 87 VA facilities that provided inpatient hemodialysis during 2018, we requested participation in a survey regarding aspects of RRT in VA ICUs. Questions centered around mode of therapy, equipment, solutions, prescription authority, nursing, anticoagulation, antimicrobial dosing, and access.Results Seventy-six centers completed the questionnaire, achieving a response rate of 87.4%. Fifty-five centers or 72.4%, reported using some form of prolonged or continuous renal replacement therapy (CRRT) in addition to intermittent hemodialysis. Of these 55 centers, 42 reported being specifically CRRT-capable. Over half of the respondents had the capabilities to perform prolonged intermittent renal replacement therapy (PIRRT). Twelve centers (21.8%) were equipped to use slow low efficient dialysis (SLED) alone. Therapy was overwhelmingly prescribed by nephrologists (94.4% of centers).Conclusions Within the VA system, ICU-related RRT practice is quite varied. Variation in processes of care, prescription authority, RRT nursing care coordination, medication management, and safety practices present opportunities for developing cross cutting measures of quality of intensive care RRT that are agnostic of modality choice.

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