ABSTRACTS from 16th International COnference on ... - CRRT Online

B10
Dialysis Dose Prescription and Delivery
Educational Objectives:
1. Discuss the importance of measuring delivered dose of dialysis.
2. To review the different methods to assess dialysis dose in AKI.
Rolando Claure MD
8:15-9:45
Wednesday, February 15
3. Discuss and identify the gaps in current practice and propose an approach ensure delivering a prescribed dose.
Content Description:
Assessing and delivering dialysis dose in acute kidney injury (AKI) has emerged as an important issue in the
management of critically ill patients. There is ongoing debate on how dose of dialysis should be expressed and
measured. Most studies have focused on clearance of small molecules (blood urea nitrogen) as a marker of delivered
dose and for establishing dose–outcome relationships. Recent evidence has shown that other markers may
also be important to consider, as acid–base balance and fluid overload have emerged as important factors contributing
to outcomes. In this workshop, we will provide an evaluation of current approaches to prescribing and
delivering dialysis dose in AKI, identify gaps in practice and propose an integrated approach to optimize dose
delivery in dialysis with a goal to improve outcomes.
Suggested Reading:
1. Overberger P, Pesacreta M, Palevsky PM: Management of renal replacement therapy in acute kidney injury: a survey of
practitioner prescribing practices. Clin J Am Soc Nephrol 2:623–630, 2007.
2. Marshall MR: Current status of dosing and quantification of acute renal replacement therapy. Part 1: mechanisms and
consequences of therapy under-delivery. Nephrology (Carlton) 11:171–180, 2006.
3. Davenport A, Bouman C, Kirpalani A, Skippen P, Tolwani A, Mehta RL, Palevsky PM: Delivery of renal replacement
therapy in acute kidney injury: what are the key issues? Clin J AmSocNephrol 3:869–875, 2008.
4. Davenport A, Farrington K: Dialysis dose in acute kidney injury and chronic dialysis. Lancet 375:705–706, 2010.
5. Gillespie RS, Seidel K, Symons JM: Effect of fluid overload and dose of replacement fluid on survival in hemofiltration.
Pediatr Nephrol 19:1394-1399, 2004.
6. Bouchard J, Soroko SB, Chertow GM, Himmelfarb J, Ikizler TA, Paganini EP, Mehta RL; Program to Improve Care in
Acute Renal Disease (PICARD) Study Group: Fluid accumulation, survival and recovery of kidney function in critically ill
patients with acute kidney injury. Kidney Int 76:422–427, 2009.
7. Gotch FA: IsKt ⁄ V urea a satisfactory measure for dosing the newer dialysis regimens? Semin Dial 14:15–17, 2001.
8. Diaz-Buxo JA, Loredo JP: Standard Kt ⁄ V: comparison of calculation methods. Artif Organs 30:178–185, 2006.
9. Claure-Del Granado R, Macedo E, Chertow G et al. Effluent volume in continuous renal replacement therapy overestimates
the delivered dose of dialysis. Clin J Am Soc Nephrol 6: 467–475, 2011.
10. Claure-Del Granado R and Mehta RL. Assessing and delivering dialysis dose. Semin Dial 24:208-14, 2011.
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