Toward the optimal dose metric in continuous renal replacement therapy
RCD Granado, E Macedo… - … journal of artificial …, 2012 - journals.sagepub.com
The International journal of artificial organs, 2012•journals.sagepub.com
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 …
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 …
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.
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