The hemodynamic tolerability and feasibility of sustained low efficiency dialysis in the management of critically ill patients with acute kidney injury

BMC Nephrology

Research Article

Heather E Fieghen¹  Jan O Friedrich²  Karen E Burns²  Neill K Adhikari³  Stephen E Lapinsky⁴  Michelle A Hladunewich⁵  Robert M Richardson⁶  Ron Wald⁷  Rosane Nisenbaum⁸ 

[1] Department of Medicine, University of Toronto, Toronto, ON, Canada;Department of Medicine, University of Toronto, Toronto, ON, Canada;Department of Critical Care, St. Michael's Hospital, Toronto, ON, Canada;The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada;Department of Medicine, University of Toronto, Toronto, ON, Canada;Department of Critical Care, Sunnybrook Health Sciences Centre, Toronto, ON, Canada;Department of Medicine, University of Toronto, Toronto, ON, Canada;Division of Critical Care, Mt. Sinai Hospital, Toronto, ON, Canada;Department of Medicine, University of Toronto, Toronto, ON, Canada;Division of Nephrology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada;Department of Medicine, University of Toronto, Toronto, ON, Canada;Division of Nephrology, University Health Network, Toronto, ON, Canada;Department of Medicine, University of Toronto, Toronto, ON, Canada;The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada;Division of Nephrology, St. Michael's Hospital, Toronto, ON, Canada;The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada;

关键词: Mean Arterial Pressure;    Renal Replacement Therapy;    Acute Kidney Injury;    Continuous Renal Replacement Therapy;    Hemodynamic Instability;   

DOI  :  10.1186/1471-2369-11-32

 received in 2010-07-22, accepted in 2010-11-25,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundMinimization of hemodynamic instability during renal replacement therapy (RRT) in patients with acute kidney injury (AKI) is often challenging. We examined the relative hemodynamic tolerability of sustained low efficiency dialysis (SLED) and continuous renal replacement therapy (CRRT) in critically ill patients with AKI. We also compared the feasibility of SLED administration with that of CRRT and intermittent hemodialysis (IHD).MethodsThis cohort study encompassed four critical care units within a single university-affiliated medical centre. 77 consecutive critically ill patients with AKI who were treated with CRRT (n = 30), SLED (n = 13) or IHD (n = 34) and completed at least two RRT sessions were included in the study. Overall, 223 RRT sessions were analyzed. Hemodynamic instability during a given session was defined as the composite of a > 20% reduction in mean arterial pressure or any escalation in pressor requirements. Treatment feasibility was evaluated based on the fraction of the prescribed therapy time that was delivered. An interrupted session was designated if < 90% of the prescribed time was administered. Generalized estimating equations were used to compare the hemodynamic tolerability of SLED vs CRRT while accounting for within-patient clustering of repeated sessions and key confounders.ResultsHemodynamic instability occurred during 22 (56.4%) SLED and 43 (50.0%) CRRT sessions (p = 0.51). In a multivariable analysis that accounted for clustering of multiple sessions within the same patient, the odds ratio for hemodynamic instability with SLED was 1.20 (95% CI 0.58-2.47), as compared to CRRT. Session interruption occurred in 16 (16.3), 30 (34.9) and 11 (28.2) of IHD, CRRT and SLED therapies, respectively.ConclusionsIn critically ill patients with AKI, the administration of SLED is feasible and provides comparable hemodynamic control to CRRT.

【 授权许可】

Unknown   
© Fieghen et al; licensee BioMed Central Ltd. 2010. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.