DOSE DIALITICA E OUTCOME: UN PROBLEMA ANCORA APERTO
|
|
- Briana Dawson
- 5 years ago
- Views:
Transcription
1 DOSE DIALITICA E OUTCOME: UN PROBLEMA ANCORA APERTO Angelo F. Perego Nefrologia e Dialisi Ospedale Vittorio Emanuele III Monselice (PD) ULSS 17 Veneto GDS SIN TRATTAMENTI DEPURATIVI IN AREA CRITICA STAMPA A COLORI 0ANTONE 0ANTONE GRIGIO ARGENTO
2 Status of issues concerning RRT use in the ICU Continuous renal replacement therapy: recent advances and future research John R. Prowle & Rinaldo Bellomo Nature Reviews Nephrology 6, (September 2010) CRRT dose A resolved issue in favor of conventional dosing (target effluent flow rate ml/kg per h)????!!!!! = 42 L/die??? CRRT versus IHD Consensus in favor of CRRT in hemodynamically unstable critically ill patients, but without formal evidence Timing of CRRT Unresolved issue that requires further research CRRT outcomes Unresolved issue; studies to date may have been too focused on mortality over renal recovery and other patient-centered outcomes CRRT modality Unresolved issue CRRT modalities might be equivalent
3
4 GFR = L/die
5 Figure 1 Relationship between delivered RRT intensity and survival in critically ill patients with acute kidney injury (AKI) John A. Kellum & Claudio Ronco (2010) Results of RENAL what is the optimal CRRT target dose? Nat. Rev. Nephrol. doi: /nrneph
6 CRRT cosa? SCUF CVVH CVVHD CVVHDF EDD; SLED SLEDD SLEDD-f CPFA NO REINFUSIONE POST-DILUIZIONE PRE-DILUIZIONE PRE+POST- DILUIZIONE
7 Effluente COSA? Ultrafiltrato puro di plasma ( post-dil)? Ultrafiltrato da pre-diluizione? Ultrafiltrato da pre+post-diluizione? Bagno di dialisi?
8 Effluent Volume in Continuous Renal Replacement Therapy Overestimates the Delivered Dose of Dialysis R. Claure-Del Granado*,Etienne Macedo*,Glenn M. Chertow,Sharon Soroko*,Jonathan Himmelfarb,T. Alp Ikizler, Emil P. Paganini,Ravindra L. Mehta* Conclusions: Effluent volume significantly overestimates delivered dose of small solutes in CRRT. To assess adequacy of CRRT, solute clearance should be measured rather than estimated by the effluent volume. CJASN March 2011 vol. 6 no
9 Percent Decrease in Solute Clearance During High-Dose Pre-Dilution CVVH #,* Troyanov et al, Nephrol Dial Transplant 2003 Filter (m 2 ) Urea Creatinine Phosphate β 2 M M ± (0.9) a ± ± ± 3.1 HF1000 (1.1) b ± ± ± ± 2.4 # : Results expressed as % decrease relative to postdilution *: Q B = ml/min; Q F = 4.5 L/hr a : mean Hct = 0.26 ± 0.04 b : mean Hct = 0.30 ± 0.05
10
11 Table 1 Randomized trials comparing CRRT with IHD in the ICU Prowle, J. R. & Bellomo, R. (2010) Continuous renal replacement therapy: recent advances and future research Nat. Rev. Nephrol. doi: /nrneph
12 CRRT-Associated Mortality in Major RCT s Clinical Trial Comparison APACHE II Endpoint Mortality Ronco et al (2000) CRRT Dose day 2 59% 3 Mehta et al (2001) IHD vs CRRT 25.5 Hospital 66% Augustine et al (2004) IHD vs CRRT - Hospital 68% Saudan et al (2006) CRRT Dose day 66% 3 Vinsonneau et al (2006) IHD vs CRRT day 68% Lins et al (2008) IHD vs CRR 27 Hospital 58% Tolwani et al (2008) CRRT Dose 26 Hospital 60% 3 ATN Trial (2008) Dialysis Dose day RENAL Trial (2009) CRRT Dose ~ day 45% 1: APACHE III score : After CRRT cessation 3: Mortality in low-dose group 4: Overall (CRRT + IHD) mortality
13 Table 2 Randomized controlled trials comparing CRRT dose in the ICU Prowle, J. R. & Bellomo, R. (2010) Continuous renal replacement therapy: recent advances and future research Nat. Rev. Nephrol. doi: /nrneph
14 Comparison of Major CRRT Dose Trials Ronco Saudan Tolwani ATN Number of patients Multi-center RCT No No No Yes CKD (%) NA Exclusion Predominant AKI cause Surgical Sepsis Sepsis Ischemia APACHE II ~ ~29 Initiation BUN (mg/dl) Modality post CVVH pre CVVHDF pre CVVHDF pre CVVHDF % Convective 100 ~ Prescribed dose (ml/kg/h) 20/35/45 25/42 20/35 20/35 Effective dose (ml/kg/h) 20/35/45 ~20/37 ~17/29 ~17/27 ICU wait (days) NA NA 8 6.9
15 ATN Study
16
17
18 Interpretation of ATN Results: A Cautionary Note for Physicians The National Cooperative Dialysis Study (NCDS) should give pause to those who favor an immediate reduction in CRRT dose NCDS was performed in US chronic HD patients during the late 1970 s First large-scale trial to study the relationship between dose and survival A flawed analysis of the data resulted in a misinterpretation of the results and a downward trend in dose prescription for 15 years in the US The results were disastrous, with residual effects still influencing clinical practice in the US The NCDS debacle argues strongly against a rush to judgment with regard to the ATN Trial results 18
19 Molecular Transport Mechanisms Ultrafiltration Diffusion Convection Adsorption } Solute Fluid Transport Transport
20
21 Sieving Characteristics caratteristiche di SETACCIO che identificano il CUT-OFF point Percent Permeated MWCO MWCO = Molecular Weight Cut-Off S = C permeate C Feed Molecular Weight (kda( kda)
22
23
24 CONSIDERAZIONE FINALE Tutta la letteratura, ad oggi, non mostra differenze, in termini di sopravvivenza, tra trattamenti intermittenti; continui; diffusivi, convettivi o combinati; ad alta o bassa dose QUALE IPOTESI UNIFICANTE PER SPIEGARE QUESTA ANGOSCIANTE ASSENZA DI RISULTATI?
25 BERNARDINO DI BETTO detto il PINTURICCHIO 1495 Perugia, Galleria Naz.Umbra
26 RIFLESSIONI INTORNO ALLA DOSE MODALITA SPETTRO RIMOZIONE QB QF QD PRE, POST, PRE+POST FILTRO: TIPO di MEMBRANA, CUT-OFF, SUPERFICIE ANTICOAGULAZIONE TIPI DI ACCESSO VASCOLARE
27 Original Paper Long-Term Clinical Results with High-Efficiency Hemofiltration G. Civati, C. Guastoni, A. Perego, U. Teatini, M. Giachetti, F. Zoppi, L. Minetti Renal Unit and Department of Biochemistry, Niguarda Ca' Granda Hospital, Milano, Italy Uremic toxicity is widely thought to be caused by the retention of a large spectrum of solutes, ranging from small to large molecular weight. Hemodialysis (HD), although achievinga high clearance of small molecules, does not permit a satisfactory removal of middleand large molecules. Conventional hemofiltration (CHF) improves the removal of middleand large molecules, but removes less small molecules compared to HD. A really satisfactory removal of small, middle and larger solutes can only be achieved by post-dilution high-efficiency hemofiltration (HEHF), surpassing the performances of both HD and CHF. On this basis the authors formulate a prescription about hemofiltration dose (2 L/KG/week). The artificial GFR given to each patient must be comparable to that of a symptom-free patient with a residual GFR of 8-10 ml/min. Vol. 1, No. 3, 1983
28
Olistic Approach to Treatment Adequacy in AKI
Toronto - Canada, 2014 Olistic Approach to Treatment Adequacy in AKI Claudio Ronco, MD Department of Nephrology, St. Bortolo Hospital, International Renal Research Institute Vicenza - Italy 1) RRT
More informationDialysis Dose Prescription and Delivery. William Clark, M.D. Claudio Ronco, M.D. Rolando Claure-Del Granado, M.D. CRRT Conference February 15, 2012
Dialysis Dose Prescription and Delivery William Clark, M.D. Claudio Ronco, M.D. Rolando Claure-Del Granado, M.D. CRRT Conference February 15, 2012 Dose in RRT: Key concepts Dose definition Quantifying
More informationCRRT for the Experience User 1. Claudio Ronco, M.D. David Selewski, M.D. Rolando Claure-Del Granado, M.D. AKI & CRRT Conference March, 2018
CRRT for the Experience User 1 Claudio Ronco, M.D. David Selewski, M.D. Rolando Claure-Del Granado, M.D. AKI & CRRT Conference March, 2018 Disclosures I have no actual or potential conflict of interest
More informationCRRT: The Technical Questions Modality & Dose. Ashita J. Tolwani, MD, MSc University of Alabama at Birmingham 2018
CRRT: The Technical Questions Modality & Dose Ashita J. Tolwani, MD, MSc University of Alabama at Birmingham 2018 Case A 24YOM with HTN and OSA presents with acute pancreatitis. Despite aggressive fluid
More informationDecision making in acute dialysis
Decision making in acute dialysis Geoffrey Bihl MB.BCh M.MED FCP(SA) Nephrologist and Director Winelands Kidney and Dialysis Centre Somerset West South Africa Important questions in AKI What is the cause?
More informationCan We Achieve Precision Solute Control with CRRT?
Can We Achieve Precision Solute Control with CRRT? Claudio Ronco, M.D. David Selewski, M.D. Rolando Claure-Del Granado, M.D. AKI & CRRT Conference February, 2019 Disclosures I have no actual or potential
More informationTiming, Dosing and Selecting of modality of RRT for AKI - the ERBP position statement
Timing, Dosing and Selecting of modality of RRT for AKI - the ERBP position statement Prof. Dr. Achim Jörres Dept. of Nephrology and Medical Intensive Care Charité University Hospital Campus Virchow Klinikum
More informationASN Board Review: Acute Renal Replacement Therapies
ASN Board Review: Acute Renal Replacement Therapies Ashita Tolwani, M.D., M.Sc. University of Alabama at Birmingham 2014 Key issues for boards: RRT for AKI When should therapy be initiated? What are the
More informationAccelerated Venovenous Hemofiltration: Early Technical and Clinical Experience
Accelerated Venovenous Hemofiltration: Early Technical and Clinical Experience Casey N. Gashti, MD, Susana Salcedo, MD, Virginia Robinson, RN, and Roger A. Rodby, MD Background: Renal replacement therapies
More informationCan We Achieve Precision Solute Control with CRRT?
Can We Achieve Precision Solute Control with CRRT? Claudio Ronco, M.D. David Selewski, M.D. Rolando Claure-Del Granado, M.D. AKI & CRRT Conference February, 2019 Disclosures I have no actual or potential
More informationWho? Dialysis for Acute Renal Failure: Who, What, How, and When? Kathleen D. Liu, MD, PhD, MAS June 2011
Dialysis for Acute Renal Failure: Who, What, How, and When? Kathleen D. Liu, MD, PhD, MAS June 2011 Dorre Nicholau MD PhD Clinical Professor Department of Anesthesia and Perioperative Care University of
More informationProf Patrick Honoré,MD, PhD,FCCM Intensivist-Nephrologist
Pro-Con Debate on High Volume Hemofiltration :Burial or Ressurection? The Pro Position 1.-Why Moving From Dose To Membranes? 4.-AN69 Oxiris LPS Adsorptive Membranes in Sepsis 2.- High Cut-Off Membranes
More informationContinuous renal replacement therapy. David Connor
Continuous renal replacement therapy David Connor Overview Classification of AKI Indications Principles Types of CRRT Controversies RIFL criteria Stage GFR Criteria Urine Output Criteria Risk Baseline
More informationMODALITIES of Renal Replacement Therapy in AKI
MODALITIES of Renal Replacement Therapy in AKI Jorge Cerdá, MD, MS, FACP, FASN Clinical Professor of Medicine Albany Medical College Albany, NY, USA cerdaj@mail.amc.edu In AKI, RRT is a multidimensional
More informationCRRT Fundamentals Pre-Test. AKI & CRRT 2017 Practice Based Learning in CRRT
CRRT Fundamentals Pre-Test AKI & CRRT 2017 Practice Based Learning in CRRT Question 1 A 72-year-old man with HTN presents to the ED with slurred speech, headache and weakness after falling at home. He
More informationSolute clearances during continuous venovenous haemofiltration at various ultrafiltration flow rates using Multiflow-100 and HF1000 filters
Nephrol Dial Transplant (2003) 18: 961 966 DOI: 10.1093/ndt/gfg055 Original Article Solute clearances during continuous venovenous haemofiltration at various ultrafiltration flow rates using Multiflow-100
More informationRenal Replacement Therapy in Acute Renal Failure
CHAPTER 82 Renal Replacement Therapy in Acute Renal Failure R. Deshpande Introduction Acute renal failure (ARF) is defined as an abrupt decrease in renal function sufficient to result in retention of nitrogenous
More informationContinuous Renal Replacement Therapy. Gregory M. Susla, Pharm.D., F.C.C.M. Associate Director, Medical Information MedImmune, LLC Gaithersburg, MD
Continuous Renal Replacement Therapy Gregory M. Susla, Pharm.D., F.C.C.M. Associate Director, Medical Information MedImmune, LLC Gaithersburg, MD 1 Definition of Terms SCUF - Slow Continuous Ultrafiltration
More informationContinuous Renal Replacement Therapy
Continuous Renal Replacement Therapy Gregory M. Susla, Pharm.D., F.C.C.M. Associate Director, Medical Information MedImmune, LLC Gaithersburg, MD Definition of Terms SCUF - Slow Continuous Ultrafiltration
More informationPD In Acute Kidney Injury. February 7 th -9 th, 2013
PD In Acute Kidney Injury February 7 th -9 th, 2013 Objectives PD as a viable initial therapy PD in AKI PD versus dhd PD versus CVVHD Why not PD first PD for AKI Early days (1970 s) PD was the option of
More informationhigher dose with progress in technical equipment. Continuous Dialysis: Dose and Antikoagulation. prescribed and delivered
1 2 Continuous Dialysis: Dose and Antikoagulation higher dose with progress in technical equipment Comparison of pump-driven and spontaneous continuous haemofiltration in postoperative acute renal failure.
More informationCRRT. Sustained low efficiency daily dialysis, SLEDD. Sustained low efficiency daily diafiltration, SLEDD-f. inflammatory cytokine IL-1 IL-6 TNF-
RRT, renal replacement therapy IHDCRRT CRRT 24 CRRT Sustained low efficiency daily dialysis, SLEDD 6 ~ 12 300 Sustained low efficiency daily diafiltration, SLEDD-f inflammatory cytokine IL-1 IL-6 TNF-
More informationQuantification and Dosing of Renal Replacement Therapy in Acute Kidney Injury: A Reappraisal
In-Depth Review Blood Purif 2017;44:140 155 Received: January 12, 2017 Accepted: April 4, 2017 Published online: June 7, 2017 Quantification and Dosing of Renal Replacement Therapy in Acute Kidney Injury:
More informationAcute Kidney Injury- What Is It and How Do I Treat It?
Acute Kidney Injury- What Is It and How Do I Treat It? Jayant Kumar, MD Renal Medicine Assoc., Albuquerque, NM Incidence of ARF in ICU Causes of ARF Non -ICU ICU 1 KDIGO criteria for AKI Increase in serum
More informationAcute Kidney Injury (AKI) How Wise is Early Dialysis in Critically Ill Patients? Modalities of Dialysis
Acute Kidney Injury (AKI) How Wise is Early Dialysis in Critically Ill Patients? A common condition in ICU patients Associated with high mortality and morbidity Renal Replacement Therapy (RRT) is the cornerstone
More informationCRRT. ICU Fellowship Training Radboudumc
CRRT ICU Fellowship Training Radboudumc Timing RRT Consider the following: Underlying cause and reversibility. Rapid improvement unlikely with high dose vasopressors and continuous exposure to other risk
More informationRENAL FAILURE IN ICU. Jo-Ann Vosloo Department Critical Care SBAH
RENAL FAILURE IN ICU Jo-Ann Vosloo Department Critical Care SBAH DEFINITION: RIFLE criteria Criteria for initiation of RRT Modes of RRT (options) CRRT = continuous renal replacement therapy SCUF : Ultra-filtration
More informationANTIBIOTIC DOSE AND DOSE INTERVALS IN RRT and ECMO
ANTIBIOTIC DOSE AND DOSE INTERVALS IN RRT and ECMO Professor Jeffrey Lipman Department of Intensive Care Medicine Royal Brisbane Hospital University of Queensland NO CONFLICT OF INTERESTS Important concept
More informationRationale for renal replacement therapy in ICU: indications, approaches and outcomes. Richard Beale
Rationale for renal replacement therapy in ICU: indications, approaches and outcomes Richard Beale RIFLE classification (ADQI group) 2004 Outcome AKIN classification Definition: Abrupt (within 48 hrs)
More informationCRRT Fundamentals Pre- and Post- Test Answers. AKI & CRRT 2017 Practice Based Learning in CRRT
CRRT Fundamentals Pre- and Post- Test Answers AKI & CRRT 2017 Practice Based Learning in CRRT Question 1 A 72-year-old man with HTN presents to the ED with slurred speech, headache and weakness after falling
More information- SLED Sustained Low-Efficiency Dialysis
Continuous Renal Replacement Therapy Gregory M. Susla, Pharm.D., F.C.C.M. Associate Director, Medical Information MedImmune, LLC Gaithersburg, MD 1 Definition of Terms - SCUF - Slow Continuous Ultrafiltration
More informationPediatric Continuous Renal Replacement Therapy
Pediatric Continuous Renal Replacement Therapy Farahnak Assadi Fatemeh Ghane Sharbaf Pediatric Continuous Renal Replacement Therapy Principles and Practice Farahnak Assadi, M.D. Professor Emeritus Department
More informationPhysiology of Blood Purification: Dialysis & Apheresis. Outline. Solute Removal Mechanisms in RRT
Physiology of Blood Purification: Dialysis & Apheresis Jordan M. Symons, MD University of Washington School of Medicine Seattle Children s Hospital Outline Physical principles of mass transfer Hemodialysis
More informationKaren Mak R.N. (Team Leader) Renal Dialysis Centre Hong Kong Sanatorium & Hospital
Karen Mak R.N. (Team Leader) Renal Dialysis Centre Hong Kong Sanatorium & Hospital - Renal Transplantation - Peritoneal Dialysis - Extracorporeal Therapy Extracorporeal Therapy It is the procedure in
More informationRenal replacement therapy in Pediatric Acute Kidney Injury
Renal replacement therapy in Pediatric Acute Kidney Injury ASCIM 2014 Dr Adrian Plunkett Consultant Paediatric Intensivist Birmingham Children s Hospital, UK Aims of the presentation Important topic: AKI
More informationOperational characteristics of continuous renal replacement modalities used for critically ill patients with acute kidney injury
The International Journal of Artificial Organs / Vol. 31 / no. 6, 2008 / pp. 525-534 Review Operational characteristics of continuous renal replacement modalities used for critically ill patients with
More informationUNDERSTANDING THE CRRT MACHINE
UNDERSTANDING THE CRRT MACHINE Helen Dickie Renal Sister Critical Care Unit Guy s and St.Thomas NHS Foundation Trust 18.10.14 RRT options - IHD vs CRRT (1) Intermittent HaemoDialysis e.g. 4hrs daily or
More informationCommentary Recent evolution of renal replacement therapy in the critically ill patient Claudio Ronco
Commentary Recent evolution of renal replacement therapy in the critically ill patient Claudio Ronco Department of Nephrology, St Bortolo Hospital, Vicenza, Italy Corresponding author: Claudio Ronco, cronco@goldnet.it
More informationPractical issues - dosing on extracorporeal circuits
Practical issues - dosing on extracorporeal circuits Jason A Roberts B Pharm (Hons), PhD, FSHP Professor of Medicine and Pharmacy The University of Queensland, Australia Royal Brisbane and Women s Hospital,
More informationRecent advances in CRRT
Recent advances in CRRT JAE IL SHIN, M.D., Ph.D. Department of Pediatrics, Severance Children s Hospital, Yonsei University College of Medicine, Seoul, Korea Pediatric AKI epidemiology and demographics
More informationLarge RCT s s in RRT : What can be learnt for nursing?
Large RCT s s in RRT : What can be learnt for nursing? Ian Baldwin Dept. of Intensive Care, Austin Hospital Adjunct Professor, RMIT University CRRT 2011 Hilton Bayfront, February 22-25 SanDiego Key Hypothesis
More informationRenal Replacement Therapy in ICU. Dr. Sunil Sharma Senior Resident Dept of Pulmonary Medicine
Renal Replacement Therapy in ICU Dr. Sunil Sharma Senior Resident Dept of Pulmonary Medicine Introduction Need for RRT in patients with ARF is a common & increasing problem in ICUs Leading cause of ARF
More informationManaging Acid Base and Electrolyte Disturbances with RRT
Managing Acid Base and Electrolyte Disturbances with RRT John R Prowle MA MSc MD MRCP FFICM Consultant in Intensive Care & Renal Medicine RRT for Regulation of Acid-base and Electrolyte Acid base load
More informationIntensity of continuous renal replacement therapy for acute kidney injury(review)
Cochrane Database of Systematic Reviews Intensity of continuous renal replacement therapy for acute kidney injury(review) Fayad AI, Buamscha DG, Ciapponi A Fayad AI, Buamscha DG, Ciapponi A. Intensity
More informationCRRT and Drug dosing. Karlee Johnston Lead Pharmacist Division of Critical Care ICU Education June 2017
CRRT and Drug dosing Karlee Johnston Lead Pharmacist Division of Critical Care ICU Education June 2017 This talk In scope CRRT modalities with regard to medicine Principles of drugs with regard to dialysis
More informationDrug dosing in patients with acute kidney injury
Drug dosing in patients with acute kidney injury They don t know what they are doing Jan Jan T. T. Kielstein Department of of Nephrology and and Hypertension Medical School School Hannover Drug dosing
More informationEnd-Stage Renal Disease. Anna Vinnikova, M.D. Associate Professor of Medicine Division of Nephrology
End-Stage Renal Disease Anna Vinnikova, M.D. Associate Professor of Medicine Division of Nephrology ESRD : Life with renal replacement therapy CASE: 18 month old male with HUS develops ESRD PD complicated
More informationCRRT Fundamentals Pre- and Post- Test. AKI & CRRT Conference 2018
CRRT Fundamentals Pre- and Post- Test AKI & CRRT Conference 2018 Question 1 Which ONE of the following statements regarding solute clearance in CRRT is MOST correct? A. Convective and diffusive solute
More informationComparing RRT Modalities: Does It Matter What You Use If The Job Is Done?
Comparing RRT Modalities: Does It Matter What You Use If The Job Is Done? Sean M Bagshaw, MD, MSc Division of Critical Care Medicine University of Alberta Disclosure Consulting: Alere, Baxter, Gambro,
More informationIL DANNO RENALE ACUTO NEL PAZIENTE CON NEFROPATIA CRONICA
IL DANNO RENALE ACUTO: ATTUALITA E PROSPETTIVE Cuneo 11 novembre 2010 IL DANNO RENALE ACUTO NEL PAZIENTE CON NEFROPATIA CRONICA Angelo Perego Nefrologia e Dialisi Ospedale Vittorio Emanuele III Monselice
More informationAquarius Study Day Adult Pre-Reading Study Pack
Aquarius Study Day Adult Pre-Reading Study Pack An Introduction to CRRT (Continuous Renal Replacement Therapy) Name Date. Hospital.. Please take the opportunity to read this booklet prior to attending
More informationToward the optimal dose metric in continuous renal replacement therapy
Int J Artif Organs 2012; 35 ( 6 ): 413-424 DOI: 10.5301/ijao.5000041 ORIGINAL ARTICLE Toward the optimal dose metric in continuous renal replacement therapy Rolando Claure-Del Granado 1, Etienne Macedo
More informationFluid Management in Critically Ill AKI Patients
Fluid Management in Critically Ill AKI Patients Sang Kyung Jo, MD, PhD Department of Internal Medicine Korea University Medical College KO/MG31/15-0017 Outline Fluid balance in critically ill patients:
More information[1] Levy [3] (odds ratio) 5.5. mannitol. (renal dose) dopamine 1 µg/kg/min atrial natriuretic peptide (ANP)
[1] Levy [3] 183 174 (odds ratio) 5.5 Woodrow [1] 1956 1989 mannitol (renal dose) dopamine 1 µg/kg/min atrial natriuretic peptide (ANP) McCarthy [2] 1970 1990 insulin-like growth factor-1 (IGF-1) ANP 92
More informationECMO & Renal Failure Epidemeology Renal failure & effect on out come
ECMO Induced Renal Issues Transient renal dysfunction Improvement in renal function ECMO & Renal Failure Epidemeology Renal failure & effect on out come With or Without RRT Renal replacement Therapy Utilizes
More informationACUTE KIDNEY INJURY. Stuart Linas U. Colorado SOM
ACUTE KIDNEY INJURY Stuart Linas U. Colorado SOM Marked increases in incidence of dialysis-requiring AKI in last decade JASN 24 37 2013 Question 1 Of patients who recover from an episode of AKI, what percentage
More informationRenal replacement therapy in acute kidney injury
6 February 2009 CONTENTS Renal replacement therapy in acute kidney injury S Jithoo Commentator: CL Quantock Moderator: LW Drummond INTRODUCTION... 3 WHAT IS RENAL REPLACEMENT THERAPY?... 3 MODES OF RENAL
More informationUAB CRRT Primer Ashita Tolwani, MD, MSc University of Alabama at Birmingham
UAB CRRT Primer 2018 Ashita Tolwani, MD, MSc University of Alabama at Birmingham 1 CRRT Primer Continuous Renal Replacement Therapy (CRRT) is a "catch all" term used for all the continuous modes of renal
More informationDialysis in the Acute Setting
Dialysis in the Acute Setting medicine2.missouri.edu/jahm/dialysis-in-the-acute-setting/ October 8, 2015 Kunal Malhotra, MD Division of Nephrology, Department of Medicine, University of Missouri School
More informationCRRT: QUALITY MANAGEMENT SYSTEMS
CRRT: QUALITY MANAGEMENT SYSTEMS Javier A. Neyra, MD, MSCS Director, Acute Care Nephrology & CRRT Program University of Kentucky Medical Center Disclosures and Funding Disclosures Consulting agreement
More informationCRRT Interactive Hyperkalemia Cases AKI & CRRT conference 2018
CRRT Interactive Hyperkalemia Cases AKI & CRRT conference 2018 Case 1 Potassium Clearance A 70 kg male is placed on CVVH with a total ultrafiltration rate (effluent rate) of 20 ml/kg/hr. The Blood Flow
More informationCRRT Interactive Hyperkalemia Cases AKI & CRRT conference 2018
CRRT Interactive Hyperkalemia Cases AKI & CRRT conference 2018 Case 1 Potassium Clearance A 70 kg male is placed on CVVH with a total ultrafiltration rate (effluent rate) of 20 ml/kg/hr. The Blood Flow
More informationRenal Replacement Therapy
Chapter 133 Renal Replacement Therapy Claudio Ronco, Zaccaria Ricci, and Stefano Romagnoli Introduction Despite recent advances in acute kidney injury (AKI) definition, diagnosis, and treatment, many aspects
More informationEffluent Volume in Continuous Renal Replacement Therapy Overestimates the Delivered Dose of Dialysis
Article Effluent Volume in Continuous Renal Replacement Therapy Overestimates the Delivered Dose of Dialysis Rolando Claure-Del Granado,* Etienne Macedo,* Glenn M. Chertow, Sharon Soroko,* Jonathan Himmelfarb,
More informationLESSONS FROM EVIDENCE BASED MEDICINEIN THE CARE OF ARF AND ESRD. Prof. Dr. Adrian Covic University of Medicine Gr. T. Popa, Iaşi
LESSONS FROM EVIDENCE BASED MEDICINEIN THE CARE OF ARF AND ESRD 2008 Prof. Dr. Adrian Covic University of Medicine Gr. T. Popa, Iaşi Effect of acute renal failure requiring renal replacement therapy on
More informationegfr 34 ml/min egfr 130 ml/min Am J Kidney Dis 2002;39(suppl 1):S17-S31
Update on Renal Therapeutics Caroline Ashley Lead Pharmacist Renal Services UCL Centre for Nephrology, Royal Free Hospital, London Kongress für Arzneimittelinformation January 2011 What are we going to
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 3,900 116,000 120M Open access books available International authors and editors Downloads Our
More informationNurse-Pharmacist Collaboration in the Delivery of Continuous Renal Replacement Therapy
Cedarville University DigitalCommons@Cedarville Pharmacy Faculty Presentations School of Pharmacy 2-23-2012 Nurse-Pharmacist Collaboration in the Delivery of Continuous Renal Replacement Therapy Jeb Ballentine
More information23/03/2018. Expensive Care. RRT in the critically ill Jill Vanmassenhove I hate to tell you this, but that should be INTENSIVE Care
RRT in the critically ill Jill Vanmassenhove 28-03-205 Expensive Care I hate to tell you this, but that should be INTENSIVE Care When to General 2 Intoxications 3 Specific clinical conditions When to General
More informationTiming, dosage and withdrawal of RRT in AKI
Timing, dosage and withdrawal of RRT in AKI! John R Prowle MSc MB BChir MRCP FFICM! Consultant Intensivist and Nephrologist! The Royal London Hospital! Outline RRT for AKI in the ICU! When to start! How
More informationSession 1: Circuit, Anticoagulation and Monitoring. Ashita Tolwani, MD, MSc Noel Oabel, BSN, RN, CNN 2019
Session 1: Circuit, Anticoagulation and Monitoring Ashita Tolwani, MD, MSc Noel Oabel, BSN, RN, CNN 2019 Goals n Learn how to set up citrate anticoagulation for CVVH, CVVHD, CVVHDF using Prismaflex n Determine
More informationContinuous renal replacement therapy Gulzar Salman Amlani Aga Khan University, School of Nursing, Karachi.
Special Communication Continuous renal replacement therapy Gulzar Salman Amlani Aga Khan University, School of Nursing, Karachi. Abstract Acute renal failure refers to sudden deterioration in biochemical
More informationAnticoagulation, delivered dose and outcomes in CRRT: The program to improve care in acute renal disease (PICARD)
Hemodialysis International 2014; : Anticoagulation, delivered dose and outcomes in CRRT: The program to improve care in acute renal disease (PICARD) Rolando CLAURE-DEL GRANADO, 1 Etienne MACEDO, 1 Sharon
More informationUpdate in Nephrology. Case: Question 1. Case presentation. Acute Kidney Injury. For her hypertension management, you decide to:
Update in Nephrology Chronic Kidney Disease Renoprotection and Proteinuria, ACE and/or ARB Anemia management Update in Nephrology Renal artery stenosis Nephrogenic systemic fibrosis Division of Nephrology
More informationoxiris A single CRRT set with multiple benefits for managing critically ill patients with AKI Adsorption of inflammatory mediators
oxiris A single CRRT set with multiple benefits for managing critically ill patients with AKI Adsorption of inflammatory mediators Heparin-grafted for reduced thrombogenicity Supports renal function POWERED
More informationAbstract. Available online
Viewpoint Dialysis dose in acute kidney injury: no time for therapeutic nihilism a critical appraisal of the Acute Renal Failure Trial Network study Claudio Ronco 1,2, Dinna Cruz 1,2, Helen Oudemans van
More informationPaul R. Bowlin, M.D. University of Colorado Denver. May 12 th, 2008
Paul R. Bowlin, M.D. University of Colorado Denver May 12 th, 2008 Presentation Overview Background / Definitions History Indications for initiation of therapy Outcomes Studies Conclusions Questions Background
More informationDrug Use in Dialysis
(Last Updated: 08/22/2018) Created by: Socco, Samantha Drug Use in Dialysis Drambarean, B. (2017). Drug Use in Dialysis. Lecture presented at PHAR 503 Lecture in UIC College of Pharmacy, Chicago. DIALYSIS
More information7/17/2017 FSHP 2017 ANNUAL MEETING. Medication Considerations for the Adult/Pediatric ICU Patient Receiving Renal Replacement Therapy
FSHP Medication Considerations for the Adult/Pediatric ICU Patient Receiving Renal Replacement Therapy Disclosure I do not have (nor does any immediate family member have) a vested interest in or affiliation
More informationTiming, dose and mode of dialysis in acute kidney injury Zaccaria Ricci a and Claudio Ronco b,c
Timing, dose and mode of dialysis in acute kidney injury Zaccaria Ricci a and Claudio Ronco b,c a Department of Pediatric Cardiac Surgery, Bambino Gesù Children s Hospital, Rome, b Department of Nephrology,
More informationDepartment of Nephrology, Centro Hospitalar de Lisboa Central Hospital de Curry Cabral, Lisboa, Portugal
REVIEW ARTICLE Advance Access publication 23 May 2013 Renal replacement therapy in critically ill patients what modality should we choose? Terapêutica substitutiva da função renal no doente crítico que
More informationNephrology PRN Focus Session AKI in the ICU: The Roles of Medication and CRRT Activity No L01-P (Knowledge-Based Activity)
Nephrology PRN Focus Session AKI in the ICU: The Roles of Medication and CRRT Activity No. 0217-0000-11-097-L01-P (Knowledge-Based Activity) Tuesday, October 18 1:30 p.m. 4:30 p.m. Convention Center: Rooms
More informationTHE HEMODIALYSIS PRESCRIPTION: TREATMENT ADEQUACY GERALD SCHULMAN MD VANDERBILT UNIVERSITY MEDICAL SCHOOL NASHVILLE, TENNESSEE
THE HEMODIALYSIS PRESCRIPTION: TREATMENT ADEQUACY GERALD SCHULMAN MD VANDERBILT UNIVERSITY MEDICAL SCHOOL NASHVILLE, TENNESSEE THE DIALYSIS CYCLE /TIME DESIGN OF THE NATIONAL COOPERATIVE DIALYSIS STUDY
More informationFiera di Vicenza Convention Center Vicenza - Italy
Regione Veneto - ULSS 6 Department of Nephrology, Dialysis and Renal Transplantation International Renal Research Institute Vicenza - IRRIV San Bortolo Hospital - Vicenza - Italy th Fiera di Vicenza Convention
More informationWhen and how to start RRT in critically ill patients? Intensive Care Training Program Radboud University Medical Centre Nijmegen
When and how to start RRT in critically ill patients? Intensive Care Training Program Radboud University Medical Centre Nijmegen Case history (1) 64 Hypertension 2004 AVR 2009 Paravalvular leak - dilated
More informationSymposium. Principles of Renal Replacement Therapy in Critically ill children- Indian Perspective
Symposium DOI- 10.21304/2018.0502.00376 in Critically ill children- Indian Perspective Sidharth Kumar Sethi *, Aliza Mittal**, Rupesh Raina***, Manindar Dhaliwal**** * Senior Consultant, Pediatric Nephrology
More informationPediatric CRRT The Basics
Pediatric CRRT The Basics Patrick Brophy Geoffrey Fleming Jordan Symons Michael Zappitelli 16 th International CRRT Conference San Diego 2011 Epidemiology Of and Indications For Pediatric CRRT ACUTE KIDNEY
More informationDrug Management in CRRT
Drug Management in CRRT Jeffrey Lipman, FCICM, MD Department of Intensive Care Medicine Royal Brisbane Hospital University of Queensland Bruce A. Mueller, PharmD, FCCP, FASN Clinical, Social & Administrative
More informationHDx THERAPY. Enabled by. Making possible personal.
HDx THERAPY Enabled by Making possible personal. THE NEXT HORIZON IN DIALYSIS IS CLOSER THAN YOU THINK PHOSPHATE UREA HDx BY THERANOVA EXPANDS YOUR RENAL POSSIBILITIES The new HDx therapy (expanded HD)
More informationBlood purification in sepsis
Blood purification in sepsis Joannes-Boyau O Dept of anesthesiology and intensive care, University Hospital of Bordeaux, France 1 Types of Blood Purification hemofilters regular pore size (MW < 40,000D)
More informationContrast Induced Nephropathy
Contrast Induced Nephropathy O CIAKI refers to an abrupt deterioration in renal function associated with the administration of iodinated contrast media O CIAKI is characterized by an acute (within 48 hours)
More informationRenal failure in sepsis and septic shock
Renal failure in sepsis and septic shock Dr. Venugopal Reddy. MD, EDIC, FCARCSI Associate Professor of Anesthesiology and Critical Care medicine Department of Anaesthesia and CCM Penn State College of
More informationNutrition in Acute Kidney Injury Enrico Fiaccadori
Nutrition in Acute Kidney Injury Enrico Fiaccadori Nephrology Dept. Parma University Medical School Parma, Italy Diagnosis, epidemiology and prognostic impact of proteinenergy wasting (PEW) in AKI Pathogenetic
More informationSeverity and Outcome of Acute Kidney Injury According to Rifle Criteria in the Intensive Care Unit
BANTAO Journal 2010; 8 (1): 35-39 BJ BANTAO Journal Original Article Severity and Outcome of Acute Kidney Injury According to Rifle Criteria in the Intensive Care Unit Albana Gjyzari 1, Elizana Petrela
More informationSection 3: Prevention and Treatment of AKI
http://www.kidney-international.org & 2012 KDIGO Summary of ommendation Statements Kidney International Supplements (2012) 2, 8 12; doi:10.1038/kisup.2012.7 Section 2: AKI Definition 2.1.1: AKI is defined
More informationThe Kidney Conundrum: Nutrition Considerations in AKI and CKD. Erin Nystrom, PharmD, BCNSP Mayo Clinic Rochester, Minnesota
The Kidney Conundrum: Nutrition Considerations in AKI and CKD Erin Nystrom, PharmD, BCNSP Mayo Clinic Rochester, Minnesota Learning Objectives 1. Evaluate recommendations and evidence for calorie and protein
More informationPrinciples of Estimating Renal Clearance, Acute Kidney Injury, and Renal Replacement in the Critically Ill Patient
Principles of Estimating Renal Clearance, Acute Kidney Injury, and Renal Replacement in the Critically Ill Patient Michael L. Bentley, Pharm.D., FCCP, FCCM, FNAP Carilion Clinic Roanoke, Virginia Principles
More informationContinuous Renal Replacement Therapy (CRRT)
ISPUB.COM The Internet Journal of Anesthesiology Volume 21 Number 1 Continuous Renal Replacement Therapy (CRRT) S Sarkar Citation S Sarkar. Continuous Renal Replacement Therapy (CRRT). The Internet Journal
More informationContinuous Renal Replacement Therapy in Dogs and Cats
Continuous Renal Replacement Therapy in Dogs and Cats Mark J. Acierno, MBA, DVM KEYWORDS Continuous renal replacement therapy CRRT Acute kidney injury Dialysis In the early 1900s, a young pharmacologist
More informationPrecision Fluid Management in Continuous Renal Replacement Therapy
ADQI Consensus Published online: August 26, 2016 Precision Fluid Management in Continuous Renal Replacement Therapy Raghavan Murugan a Eric Hoste d, e Ravindra L. Mehta c Sara Samoni f Xiaoqiang Ding h
More information