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. 2013 Dec 11;8(12):e81697.
doi: 10.1371/journal.pone.0081697. eCollection 2013.

Extended daily dialysis in acute kidney injury patients: metabolic and fluid control and risk factors for death

Daniela Ponce  1 , Juliana Maria Gera Abrão  1 , Bianca Ballarin Albino  1 , André Luis Balbi  1
Affiliations

Extended daily dialysis in acute kidney injury patients: metabolic and fluid control and risk factors for death

Daniela Ponce et al. PLoS One. .

Abstract

Intermittent hemodialysis (IHD) and continuous renal replacement therapies (CRRT) are used as Acute Kidney Injury (AKI) therapy and have certain advantages and disadvantages. Extended daily dialysis (EDD) has emerged as an alternative to CRRT in the management of hemodynamically unstable AKI patients, mainly in developed countries.

Objectives: We hypothesized that EDD is a safe option for AKI treatment and aimed to describe metabolic and fluid control of AKI patients undergoing EDD and identify complications and risk factors associated with death.

Study selection: This is an observational and retrospective study describing introduction of EDD at our institution. A total of 231 hemodynamically unstable AKI patients (noradrenalin dose between 0.3 and 1.0 ucg/kg/min) were assigned to 1367 EDD session. EDD consisted of 6-8 h of HD 6 days a week, with blood flow of 200 ml/min, dialysate flows of 300 ml/min.

Data synthesis: Mean age was 60.6±15.8 years, 97.4% of patients were in the intensive care unit, and sepsis was the main etiology of AKI (76.2). BUN and creatinine levels stabilized after four sessions at around 38 and 2.4 mg/dl, respectively. Fluid balance decreased progressively and stabilized around zero after five sessions. Weekly delivered Kt/V was 5.94±0.7. Hypotension and filter clotting occurred in 47.5 and 12.4% of treatment session, respectively. Regarding AKI outcome, 22.5% of patients presented renal function recovery, 5.6% of patients remained on dialysis after 30 days, and 71.9% of patients died. Age and focus abdominal sepsis were identified as risk factors for death. Urine output and negative fluid balance were identified as protective factors.

Conclusions: EDD is effective for AKI patients, allowing adequate metabolic and fluid control. Age, focus abdominal sepsis, and lower urine output as well as positive fluid balance after two EDD sessions were associated significantly with death.

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Conflict of interest statement

Competing Interests: Daniela Ponce is a PLOS ONE Editorial Board member and this does not alter the authors’ adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Inclusion and outcome of patients enrolled in the study.
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References

    1. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, et al. (2005) Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 294: 813–881. - PubMed
    1. Ricci Z, Ronco C, D′amico G, De Felice R, Rossi S, et al. (2006) Practice Patterns in the Management of Acute Renal Failure in the Critically Ill Patient: An International Survey. Nephrol Dial Transplant 21(3): 690–696. - PubMed
    1. Ikizler TA, Himmelfarb J (2007) Acute kidney injury: changing lexicography, definitions, and epidemiology. Kidney Inter 71: 971–976. - PubMed
    1. Mehta RL, McDonald B, Gabbai FB, Pahl M, Pascual MT, et al. (2001) A randomized clinical trial of continuous versus intermittent dialysis for acute renal failure. Kidney Int 60: 1154–1163. - PubMed
    1. Himmelfarb J (2007) Continuous dialysis is not superior to intermittent dialysis in acute kidney injury of critically ill patient. Nat Clin Pract Nephrol 3: 120–121. - PubMed

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