Toward the optimal dose metric in continuous renal replacement therapy
Contribuinte(s) |
UNIVERSIDADE DE SÃO PAULO |
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Data(s) |
01/11/2013
01/11/2013
02/08/2013
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Resumo |
Purpose: There is no consensus on the optimal method to measure delivered dialysis dose in patients with acute kidney injury (AKI). The use of direct dialysate-side quantification of dose in preference to the use of formal blood-based urea kinetic modeling and simplified blood urea nitrogen (BUN) methods has been recommended for dose assessment in critically-ill patients with AKI. We evaluate six different blood-side and dialysate-side methods for dose quantification. Methods: We examined data from 52 critically-ill patients with AKI requiring dialysis. All patients were treated with pre-dilution CWHDF and regional citrate anticoagulation. Delivered dose was calculated using blood-side and dialysis-side kinetics. Filter function was assessed during the entire course of therapy by calculating BUN to dialysis fluid urea nitrogen (FUN) ratios q/12 hours. Results: Median daily treatment time was 1,413 min (1,260-1,440). The median observed effluent volume per treatment was 2,355 mL/h (2,060-2,863) (p<0.001). Urea mass removal rate was 13.0 +/- 7.6 mg/min. Both EKR (r(2)=0.250; p<0.001) and K-D (r(2)=0.409; p<0.001) showed a good correlation with actual solute removal. EKR and K-D presented a decline in their values that was related to the decrease in filter function assessed by the FUN/BUN ratio. Conclusions: Effluent rate (ml/kg/h) can only empirically provide an estimated of dose in CRRT. For clinical practice, we recommend that the delivered dose should be measured and expressed as K-D. EKR also constitutes a good method for dose comparisons over time and across modalities. International Society of Nephrology (ISN) Fellowship award International Society of Nephrology (ISN) Fellowship award National Institutes of Health (NIH-NIDDK) [RO1-DK53412, RO1-DK53411, RO1-DK53413] National Institutes of Health (NIHNIDDK) NIHNIDDK OBrien Center NIH-NIDDK O'Brien Center |
Identificador |
INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS, MILAN, v. 35, n. 6, supl. 1, Part 2, pp. 413-424, JUN, 2012 0391-3988 http://www.producao.usp.br/handle/BDPI/37289 10.5301/ijao.5000041 |
Idioma(s) |
eng |
Publicador |
WICHTIG EDITORE MILAN |
Relação |
INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS |
Direitos |
closedAccess Copyright WICHTIG EDITORE |
Palavras-Chave | #DIALYSIS #DOSE #UREA #CLEARANCE #ACUTE KIDNEY INJURY #CRITICALLY-ILL PATIENTS #CONTINUOUS VENOVENOUS HEMOFILTRATION #RANDOMIZED-TRIAL #FAILURE PATIENTS #DIALYSIS #UREA #QUANTIFICATION #HEMODIALYSIS #INTENSITY #SURVIVAL #ENGINEERING, BIOMEDICAL #TRANSPLANTATION |
Tipo |
article original article publishedVersion |