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 CVVHDF 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 (r²=0.250; p<0.001) and KD (r²=0.409; p<0.001) showed a good correlation with actual solute removal. EKR and KD 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 KD. EKR also constitutes a good method for dose comparisons over time and across modalities.
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 ureanitrogen (BUN) methods has been recommended for dose assessment in critically-illpatients with AKI. We evaluate six different blood-side and dialysate-side methods for dose quantification. METHODS: We examined data from 52 critically-illpatients with AKI requiring dialysis. All patients were treated with pre-dilution CVVHDF 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 ureanitrogen (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 (r²=0.250; p<0.001) and KD (r²=0.409; p<0.001) showed a good correlation with actual solute removal. EKR and KD 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 KD. EKR also constitutes a good method for dose comparisons over time and across modalities.
Authors: Rolando Claure-Del Granado; Etienne Macedo; Glenn M Chertow; Sharon Soroko; Jonathan Himmelfarb; T Alp Ikizler; Emil P Paganini; Ravindra L Mehta Journal: Clin J Am Soc Nephrol Date: 2010-11-29 Impact factor: 8.237
Authors: Ashita J Tolwani; Ruth C Campbell; Brenda S Stofan; K Robin Lai; Robert A Oster; Keith M Wille Journal: J Am Soc Nephrol Date: 2008-03-12 Impact factor: 10.121
Authors: Paul M Palevsky; Jane Hongyuan Zhang; Theresa Z O'Connor; Glenn M Chertow; Susan T Crowley; Devasmita Choudhury; Kevin Finkel; John A Kellum; Emil Paganini; Roland M H Schein; Mark W Smith; Kathleen M Swanson; B Taylor Thompson; Anitha Vijayan; Suzanne Watnick; Robert A Star; Peter Peduzzi Journal: N Engl J Med Date: 2008-05-20 Impact factor: 91.245
Authors: Victor Gura; Matthew B Rivara; Scott Bieber; Raj Munshi; Nancy Colobong Smith; Lori Linke; John Kundzins; Masoud Beizai; Carlos Ezon; Larry Kessler; Jonathan Himmelfarb Journal: JCI Insight Date: 2016-06-02