Low‐Efficiency Acute Renal Replacement Therapy: Role in Acute Kidney Injury

The methodology, prescription, and delivery of acute renal replacement therapy are rapidly evolving areas. Recent clinical trials have provided clearer guidance around dosing targets for both therapy prescription and delivery. In this article, we discuss dialysis efficiency which is an area that subserves dialysis dose and pertains to manner in which a given dose is delivered. Dialysis efficiency directly effects the measurement and calculation of dose, and the occurrence of dialysis disequilibrium and hemodynamic instability. We provide recommendations around selecting the most appropriate clinical scenario and patients for higher‐efficiency versus lower‐efficiency therapy, and the implementation of therapy to achieve a given efficiency.

[1]  D. Fliser,et al.  The Hannover Dialysis Outcome study: comparison of standard versus intensified extended dialysis for treatment of patients with acute kidney injury in the intensive care unit. , 2009, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[2]  P. Peduzzi,et al.  Intensity of renal support in critically ill patients with acute kidney injury. , 2008, The New England journal of medicine.

[3]  T. Greene,et al.  Dosing intermittent haemodialysis in the intensive care unit patient with acute renal failure--estimation of urea removal and evidence for the regional blood flow model. , 2008, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[4]  R. Oster,et al.  Standard versus high-dose CVVHDF for ICU-related acute renal failure. , 2008, Journal of the American Society of Nephrology : JASN.

[5]  R. Rodby,et al.  Accelerated venovenous hemofiltration: early technical and clinical experience. , 2008, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[6]  M. Tonelli,et al.  Renal replacement therapy in patients with acute renal failure: a systematic review. , 2008, JAMA.

[7]  Anthony Delaney,et al.  Continuous versus intermittent renal replacement therapy for critically ill patients with acute kidney injury: A meta-analysis* , 2008, Critical care medicine.

[8]  J. Chiche,et al.  Continuous venovenous haemodiafiltration versus intermittent haemodialysis for acute renal failure in patients with multiple-organ dysfunction syndrome: a multicentre randomised trial , 2006, The Lancet.

[9]  P. Marcelino,et al.  [Hybrid or continuous renal replacement techniques for unstable haemodynamic patients in the intensive care unit]. , 2006, Acta medica portuguesa.

[10]  J Bakker,et al.  Abdominal compartment syndrome , 2004 .

[11]  D. Fliser,et al.  A single-pass batch dialysis system: an ideal dialysis method for the patient in intensive care with acute renal failure , 2004, Current opinion in critical care.

[12]  M. Marshall,et al.  Sustained low-efficiency daily diafiltration (SLEDD-f) for critically ill patients requiring renal replacement therapy: towards an adequate therapy. , 2004, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[13]  P. Flakoll,et al.  Urea space and total body water measurements by stable isotopes in patients with acute renal failure. , 2004, Kidney international.

[14]  D. Fliser,et al.  Efficacy and cardiovascular tolerability of extended dialysis in critically ill patients: a randomized controlled study. , 2004, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[15]  T. Greene,et al.  Prescribing an equilibrated intermittent hemodialysis dose in intensive care unit acute renal failure. , 2003, Kidney international.

[16]  W. Clark,et al.  Kinetic comparison of different acute dialysis therapies. , 2003, Artificial organs.

[17]  C. Ronco,et al.  Interventional Nephrology and Dialysis: Continuous Flow Peritoneal Dialysis: Principles and Applications , 2003 .

[18]  N Fealy,et al.  Prolonged intermittent renal replacement therapy in the intensive care unit. , 2002, Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine.

[19]  T. Golper,et al.  Urea kinetics during sustained low-efficiency dialysis in critically ill patients requiring renal replacement therapy. , 2002, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[20]  R. Khanna,et al.  Is peritoneal dialysis adequate for hypercatabolic acute renal failure in developing countries? , 2002, Kidney international.

[21]  T. Golper,et al.  Sustained low-efficiency dialysis for critically ill patients requiring renal replacement therapy. , 2001, Kidney international.

[22]  A. Davenport.  Renal replacement therapy in the patient with acute brain injury. , 2001, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[23]  B. Larive,et al.  Prescription of Adequate Renal Replacement in Critically Ill Patients , 2000, Blood Purification.

[24]  G. Hanique,et al.  Prospective evaluation of short-term, high-volume isovolemic hemofiltration on the hemodynamic course and outcome in patients with intractable circulatory failure resulting from septic shock , 2000, Critical care medicine.

[25]  J. Floege,et al.  Extended daily veno-venous high-flux haemodialysis in patients with acute renal failure and multiple organ dysfunction syndrome using a single path batch dialysis system. , 2000, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[26]  W. van Biesen,et al.  Dialysing the patient with acute renal failure in the ICU: the emperor's clothes? , 1999, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[27]  B. Charra,et al.  Quest for postdialysis urea rebound-equilibrated Kt/V with only intradialytic urea samples. , 1999, Kidney international.

[28]  R. Bellomo,et al.  Brain density changes during renal replacement in critically ill patients with acute renal failure. Continuous hemofiltration versus intermittent hemodialysis. , 1999, Journal of nephrology.

[29]  T. Ikizler,et al.  Measurement of the delivery of dialysis in acute renal failure. , 1999, Kidney international.

[30]  W. Clark,et al.  Quantifying the effect of changes in the hemodialysis prescription on effective solute removal with a mathematical model. , 1999, Journal of the American Society of Nephrology : JASN.

[31]  B. Charra,et al.  Is Post-Dialysis Urea Rebound Significant with Long Slow Hemodialysis? , 1998, Blood Purification.

[32]  M. Wahl,et al.  Brain edema: pathogenesis and therapy. , 1997, Kidney international. Supplement.

[33]  S. Silver.  Cerebral edema after rapid dialysis is not caused by an increase in brain organic osmolytes. , 1995, Journal of the American Society of Nephrology : JASN.

[34]  J T Daugirdas,et al.  Overestimation of hemodialysis dose depends on dialysis efficiency by regional blood flow but not by conventional two pool urea kinetic analysis. , 1995, ASAIO journal.

[35]  J T Daugirdas,et al.  Simplified equations for monitoring Kt/V, PCRn, eKt/V, and ePCRn. , 1995, Advances in renal replacement therapy.

[36]  J. Daugirdas,et al.  Formal analytical solution to a regional blood flow and diffusion based urea kinetic model. , 1994, ASAIO journal.

[37]  A. Arieff.  Dialysis disequilibrium syndrome: current concepts on pathogenesis and prevention. , 1994, Kidney international.

[38]  S. Gullans,et al.  The role of organic osmolytes in the cerebral cell volume regulatory response to acute and chronic renal failure. , 1993, Journal of the American Society of Nephrology : JASN.

[39]  M. H. Murphy,et al.  Urea kinetics during continuous hemofiltration. , 1992, ASAIO journal.

[40]  T. Depner.  Prescribing Hemodialysis: A Guide to Urea Modeling , 1990 .

[41]  A. Kuthiala,et al.  Sustained low-efficiency daily dialysis with hemofiltration for acute kidney injury in the presence of sepsis. , 2008, Clinical nephrology.

[42]  C. Ronco,et al.  Continuous flow peritoneal dialysis: current state-of-the-art and obstacles to further development. , 2006, Contributions to nephrology.

[43]  R. Bellomo,et al.  Prolonged daily intermittent renal replacement therapy in ICU patients by ICU nurses and ICU physicians. , 2004, The International journal of artificial organs.

[44]  T. Depner,et al.  Solute transport mechanisms in dialysis , 2004 .

[45]  C. Ronco,et al.  Continuous flow peritoneal dialysis: principles and applications. , 2003, Seminars in dialysis.

[46]  M. Leblanc,et al.  Continuous versus intermittent renal replacement therapy: a meta-analysis , 2001, Intensive Care Medicine.

[47]  FRANK M. PARSONS,et al.  Replacement of Renal Function by Dialysis , 1983, Springer Netherlands.