Skip to main content
SpringerLink
Log in

Quantifying the Dose of Acute Kidney Replacement Therapy

  • Chapter
  • First Online:
Management of Acute Kidney Problems

  • 2484 Accesses

Abstract

During acute kidney replacement therapy the amount (dose) of delivered therapy can be described by various terms: efficiency, intensity, efficacy, frequency, and clinical efficacy. Efficiency is represented by the concept of clearance (K), that is, the volume of blood cleared of a solute over a given time; the clearance does not reflect the overall solute removal rate but rather its value normalized by the serum concentration. Intensity can be defined by the product of clearance and time (Kt); this is more useful than clearance alone in comparing various therapies; however, it does not take into account the size of the pool from which the solute needs to be cleared. Efficacy is the effective solute removal resulting from the administration of a treatment dose to a patient. It can be described as a fractional clearance of a given solute (Kt/V) where V is the volume of distribution of the marker molecule in the body. Clinical efficiency can only be assessed by adequately powered prospective randomized clinical studies. The evidence available to date supports the use of at least 35 ml/h/kg for CVVH, CVVHD, or CVVHDF, or 1.2 Kt/V daily intermittent hemodialysis in treating patients with acute kidney failure.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Ronco C for the Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators. Acute Renal Failure in Critically Ill Patients A Multinational, Multicenter Study. JAMA 2005; 294: 813–818.

    Article  CAS  PubMed  Google Scholar 

  2. Lameire N, van Biesen W, Van Holder R, Colardijn F. The place of intermittent hemodialysis in the treatment of acute renal failure in the ICU patient. Kidney Int 1998; 53(Suppl 66): S110–S119.

    Google Scholar 

  3. Levy EM, Ascoli CM, Horowitz RJ. The effect of acute renal failure on mortality. JAMA 1996; 275: 1489–1494.

    Article  CAS  PubMed  Google Scholar 

  4. DuBose T, Warnock DG, Mehta RL, Bonventre JV, Hammerman MR, Molitoire DA et al. Acute renal failure in the 21st century: recommendation for management and outcomes assessment. Am J Kidney Dis 1997; 29: 793–799.

    Article  PubMed  Google Scholar 

  5. Chertow GM, Levy EM, Hammermeister KE, Grover F, Dailey J: Independent association between acute renal failure and mortality following cardiac surgery. Am J Med 1998; 104: 343–348.

    Article  CAS  PubMed  Google Scholar 

  6. Bellomo R, Ronco C, Kellum JA, Mehta R, Palevsky P, The ADQI workgroup: Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004; 8(4): R204–212.

    Article  PubMed  Google Scholar 

  7. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A for the Acute Kidney Injury Network. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Critical Care 2007; 11: R31.

    Article  PubMed  Google Scholar 

  8. Ricci Z, Bellomo R, Ronco C. Dose of dialysis in acute renal failure. Clin J Am Soc Nephrol. 2006; 1: 380–388.

    Article  PubMed  Google Scholar 

  9. Ricci Z, Ronco C, D’amico G, De Felice R, Rossi S, Bolgan I, Bonello M, Zamperetti N, Petras D, Salvatori G, Dan M, Piccinni P. Practice patterns in the management of acute renal failure in the critically ill patient: an international survey. Nephrol Dial Transplant. 2006; 21: 690–696.

    Article  PubMed  Google Scholar 

  10. Ricci Z, Salvatori G, Bonello M, Bolgan I, D’Amico G, Dan M, Piccinni P and Ronco C. In vivo validation of the adequacy calculator for continuous renal replacement therapies. Critical Care 2005; 9: R266–R273.

    Article  PubMed  Google Scholar 

  11. Gotch F, Sargent J. A mechanistic analysis of the National Cooperative Dialysis Study (NCDS). Kidney Int 1985; 28:526–534.

    Article  CAS  PubMed  Google Scholar 

  12. Parker T, Hushni L, Huang W, Lew N, Lowrie E. Survival of hemodialysis patients in the United States is improved with a greater quantity of dialysis. Am J Kidney Dis 1994; 23: 670–680.

    PubMed  Google Scholar 

  13. Eknoyan G, Levin N. NKF-K/DOQI clinical practice guidelines: update 2000. Am J Kidney Dis 2001; 38: 917.

    Google Scholar 

  14. Eknoyan G, Beck GJ, Cheung AK, Daugirdas JT, Greene T, Kusek JW, Allon M, Bailey J, Delmez JA, Depner TA, Dwyer JT, Levey AS, Levin NW, Milford E, Ornt DB, Rocco MV, Schulman G, Schwab SJ, Teehan BP, Toto R; Hemodialysis (HEMO) Study Group. Effect of dialysis dose and membrane flux in maintenance hemodialysis. N Engl J Med 2002; 347: 2010–2009.

    Article  PubMed  Google Scholar 

  15. Ronco C, Bellomo R, Homel P, et al: Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet 2000; 356: 26–30.

    Article  CAS  PubMed  Google Scholar 

  16. Saudan P, Niederberger M, De Seigneux S, Romand J, Pugin J, Perneger T and Martin PY. Adding a dialysis dose to ­continuous hemofiltration increases survival in patients with acute renal failure. Kidney Int 2006; 70: 1312–1317.

    Article  CAS  PubMed  Google Scholar 

  17. Dellinger PR, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004; 32: 858–873.

    Article  PubMed  Google Scholar 

  18. Brophy PD, Bunchman TE. References and overview for hemofiltration in pediatrics and adolescents. www.pcrrt.com. Last access 23/08/2007.

  19. Sigler MH, Teehan BP, Daugirdas JT, Ing TS. Slow continuous therapies. In: Daugirdas JT, Blake PG, Todd SI. Handbook of Dialysis, 3rd edition, 2001, Lippincott Williams & Wilkins Philadelphia (PA) USA.

    Google Scholar 

  20. Garred L, Leblanc M, Canaud B. Urea kinetic modeling for CRRT. Am J Kidney Dis 1997; 30(Suppl 4): S2–9.

    Article  CAS  PubMed  Google Scholar 

  21. Goldstein SL, Currier H, Graf C, Cosio CC, Brewer ED, Sachdeva R (2001). Outcome in children receiving continuous veno-venous hemofiltration. Pediatrics; 107:1309–1312.

    Article  CAS  PubMed  Google Scholar 

  22. Foland JA, Fortenberry JD, Warshaw BL, Pettignano R, Merritt RK, Heard ML, Rogers K, Reid C, Tanner AJ, Easley KA (2004). Fluid overload before continuous hemofiltration and survival in critically ill children: a retrospective analysis. Crit Care Med; 32: 1771–1776.

    Article  PubMed  Google Scholar 

  23. Brause M, Nuemann A, Schumacher T et al. Effect of filtration volume of continuous venovenous hemofiltration in the treatment of patients with acute renal failure in intensive care units. Critical Care Med 2003; 31: 841–846.

    Article  CAS  Google Scholar 

  24. Paganini EP, Tapolyai M, Goormastic M, Halstenberg W, Kozlowski L, Leblanc M, Lee JC, Moreno L, Sakai K. Establishing a dialysis therapy/patient outcome link in intensive care unit acute dialysis for patients with acute renal failure. Am J Kidney Dis 1996; 28(Suppl 3): S81–S89.

    Article  Google Scholar 

  25. Paganini EP, Kanagasundaram NS, Larive B, Greene T. Prescription of Adequate Renal Replacement in Critically Ill Patients. Blood Purif 2001; 19: 238–244.

    Article  CAS  PubMed  Google Scholar 

  26. Schiffl H, Lang SM, Fischer R. Daily hemodialysis and the outcome of acute renal failure. N Engl J Med 2002; 346: 305–310.

    Article  PubMed  Google Scholar 

  27. Uchino S, Bellomo R, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Oudemans-van Straaten H, Ronco C, Kellum JA. Continuous renal replacement therapy: A worldwide practice survey : The Beginning and Ending Supportive Therapy for the Kidney (B.E.S.T. Kidney) Investigators. Intensive Care Med. 2007; 27 [Epub ahead of print].

    Google Scholar 

  28. Bouman C, Oudemans-van Straaten H, Tijssen J, et al. Effects of early high-volume continuous veno-venous hemofiltration on survival and recovery of renal function in intensive care patients with acute renal failure: a prospective randomized trial. Crit Care Med 2002; 30: 2205–2211.

    Article  PubMed  Google Scholar 

  29. Kellum JA. Renal replacement therapy in critically ill patients with acute renal failure: does a greater dose improve survival? Nat Clin Pract Nephrol. 2007 Mar; 3(3): 128–129.

    Article  PubMed  Google Scholar 

  30. Uchino S, Fealy N, Baldwin I, Morimatsu H, Bellomo R. Continuous is not continuous: the incidence and impact of circuit “down-time” on uraemic control during continuous veno-venous haemofiltration. Intensive Care Med. 2003; 29: 575–578.

    Article  PubMed  Google Scholar 

  31. Evanson JA, Himmelfarb J, Wingard R, et al. Prescribed versus delivered dialysis in acute renal failure patients. Am J Kidney Dis 1998; 32: 731–738.

    Article  CAS  PubMed  Google Scholar 

  32. Venkataraman R, Kellum JA, Palevsky P. Dosing patterns for CRRT at a large academic medical center in the United States. J Crit Care 2002; 17: 246–250.

    Article  PubMed  Google Scholar 

  33. Uchino S, Bellomo R, Kellum JA, Morimatsu H, Morgera S, Schetz MR, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Oudemans-Van Straaten HM, Ronco C; Beginning and Ending Supportive Therapy for the Kidney (B.E.S.T. Kidney) Investigators Writing Committee. Patient and kidney survival by dialysis modality in critically ill patients with acute kidney injury. Int J Artif Organs. 2007; 30: 281–292.

    CAS  PubMed  Google Scholar 

  34. Depner TA. Benefits of more frequent dialysis: lower TAC at the same Kt/V. Nephrol Dial Transplant 1998; 13(Suppl 6): 20–24.

    Article  PubMed  Google Scholar 

  35. Clark WR, Mueller BA, Kraus MA, Macias WL. Renal replacement quantification in acute renal failure. Nephrol Dial Transplant 1998; 13(Suppl 6): 86–90.

    Article  PubMed  Google Scholar 

  36. Mehta RL, McDonald B, Gabbai FB, et al: A randomized clinical trial of continuous versus intermittent dialysis for acute renal failure. Kidney Int 2001; 60: 1154–1163.

    Article  CAS  PubMed  Google Scholar 

  37. Augustine J J, Sandy D, Seifert TH, Paganini EP, A randomized controlled trial comparing intermittent with continuous dialysis in patients with AKI. Am J Kidney Dis 2004; 44: 1000–1007.

    Article  PubMed  Google Scholar 

  38. Kellum J, Angus DC, Johnson JP, et al: Continuous versus intermittent renal replacement therapy: A meta-analysis. Intensive Care Med 2002; 28: 29–37.

    Article  PubMed  Google Scholar 

  39. Tonelli M, Manns B, Feller-Kopman D. Acute renal failure in the intensive care unit: A systematic review of the impact of dialytic modality on mortality and renal recovery. Am J Kidney Dis 2002; 40: 875–885.

    Article  PubMed  Google Scholar 

  40. Cho KC, Himmelfarb J, Paganini E, Ikizler TA, Soroko SH, Mehta RL, Chertow GM. Survival by dialysis modality in critically ill patients with acute kidney injury. J Am Soc Nephrol. 2006; 17: 3132–3138.

    Article  PubMed  Google Scholar 

  41. Vinsonneau C, Camus C, Combes A, Costa de Beauregard MA, Klouche K, Boulain T, Pallot JL, Chiche JD, Taupin P, Landais P, Dhainaut JF, Hemodiafe Study Group. Continuous venovenous haemodiafiltration versus intermittent haemodialysis for acute renal failure in patients with multiple-organ dysfunction syndrome: a multicentre randomised trial. Lancet. 2006; 29: 379–385.

    Article  Google Scholar 

  42. Kellum J, Palevsky PM. Renal support in acute kidney injury. Lancet 2006; 29: 344–345.

    Article  Google Scholar 

  43. Guerin C, Girard R, Selli JM, Ayzac L. Intermittent versus continuous renal replacement therapy for acute renal failure in intensive care units: results from a multicenter prospective epidemiological survey. Intensive Care Med 2002; 28: 1411–1418.

    Article  PubMed  Google Scholar 

  44. Uehlinger DE, Jakob SM, Ferrari P, Eichelberger M, Huynh-Do U, Marti HP, Mohaupt MG, Vogt B, Rothen HU, Regli B, Takala J, Frey FJ. Comparison of continuous and intermittent renal replacement therapy for acute renal failure. Nephrol Dial Transplant. 2005; 20: 1630–1637.

    Article  PubMed  Google Scholar 

  45. Schortgen F, Soubrier N, Delclaux C, Thuong M, Girou E, Brun-Buisson C, Lemaire F, Brochard L. Hemodynamic tolerance of intermittent hemodialysis in critically ill patients: usefulness of practice guidelines. Am J Respir Crit Care Med 2000; 162: 197–202.

    CAS  PubMed  Google Scholar 

  46. Butler R, Keenan SP, Inman KJ, Sibbald, WJ, Block G. Is there a preferred technique for weaning the difficult-to-wean patient? A systematic review of the literature. Crit Care Med 1999; 27: 2331–2336.

    Article  CAS  PubMed  Google Scholar 

  47. Bell M; SWING, Granath F, Schon S, Ekbom A, Martling CR. Continuous renal replacement therapy is associated with less chronic renal failure than intermittent haemodialysis after acute renal failure. Intensive Care Med 2007; 33: 773–780.

    Article  PubMed  Google Scholar 

  48. Jacka MJ, Ivancinova X, Gibney RT. Continuous renal replacement therapy improves renal recovery from acute renal failure. Can J Anaesth 2005; 52: 327–332.

    Article  PubMed  Google Scholar 

  49. Marshall MR, Golper TA, Shaver MJ, Alam MG, Chatoh DK. Urea kinetics during sustained low efficiency dialysis in critically ill patients requiring renal replacement therapy. Am J Kidney Dis 2002; 39: 556–570.

    Article  CAS  PubMed  Google Scholar 

  50. Naka T, Baldwin I, Bellomo R, Fealy N, Wan L. Prolonged daily intermittent renal replacement therapy in ICU patients by ICU nurses and ICU physicians. Int J of Artif Organs 2004; 27: 380–387.

    CAS  Google Scholar 

  51. Kumar VA, Craig M, Depner T, Yeun JY. Extended daily dialysis: A new approach to renal replacement for acute renal failure in the intensive care unit. Am J Kidney Dis, 2000; 36: 294–300.

    Article  CAS  PubMed  Google Scholar 

  52. Kielstein JT, Kretschmer U, Ernst T, Hafer C, Bahr MJ, Haller H, Fliser D. Efficacy and cardiovascular ­tolerability of extended dialysis in critically ill patients: A randomized controlled study. Am J Kidney Dis 2004; 43: 342–349.

    Article  CAS  PubMed  Google Scholar 

  53. Baldwin I, Naka T, Koch B, Fealy N, Bellomo R. A pilot randomised controlled comparison of continuous veno-venous haemofiltration and extended daily dialysis with filtration: effect on small solutes and acid-base balance. Intensive Care Med. 2007; 33: 830–835.

    Article  CAS  PubMed  Google Scholar 

  54. Tolwani AJ, Campbell RC, Stofan BS, et al. (2008). Standard versus High-Dose CVVHDF for ICU-Related Acute Renal Failure. J Am Soc Nephrol 19: 1233–1238.

    Article  PubMed  Google Scholar 

  55. The VA/NIH Acute Renal Failure Trial Network (2008). Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med [epub ahead of print].

    Google Scholar 

  56. Bonventre JV (2008). Dialysis in acute kidney injury – More is not better. N Engl J Med [epub ahead of print].

    Google Scholar 

  57. Kellum JA, Mehta R, Angus DC, Palevsky P, Ronco C, for the ADQI Workgroup. The First International Consensus Conference on Continuous Renal Replacement Therapy. Kidney Int 2002; 62: 1855–1863.

    Article  PubMed  Google Scholar 

  58. www.adqi.net

Download references

Author information

Authors and Affiliations

  1. Department of Pediatric Cardiosurgery, Bambino Gesù Hospital, Piazza S. Onofrio 4, 00100, Rome, Italy

    Zaccaria Ricci

Authors
  1. Zaccaria Ricci
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Claudio Ronco
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zaccaria Ricci .

Editor information

Editors and Affiliations

  1. Charité Campus Virchow, Universitätsklinikum Berlin, Augustenburger Platz 1, Berlin, 13353, Germany

    Achim Jörres

  2. Dipto. Nefrologia, Ospedale San Bortolo, Viale Rodolfi 16, Vicenza, 36100, Italy

    Claudio Ronco

  3. School of Medicine, University of Pittsburgh, Terrace Street 3550, Pittsburgh, 15261, U.S.A.

    John A. Kellum

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Ricci, Z., Ronco, C. (2010). Quantifying the Dose of Acute Kidney Replacement Therapy. In: Jörres, A., Ronco, C., Kellum, J. (eds) Management of Acute Kidney Problems. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-69441-0_54

Download citation

  • DOI: https://doi.org/10.1007/978-3-540-69441-0_54

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-69413-7

  • Online ISBN: 978-3-540-69441-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation