Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial

Ronco, Claudio; Bellomo, Rinaldo; Homel, Peter; Brendolan, Alessandra; Dan, Maurizio; Piccinni, Pasquale; Greca, Gluseppe La

doi:10.1016/s0140-6736(00)02430-2

Cited by 1,433 publications

(460 citation statements)

References 12 publications

Supporting

Mentioning

424

Contrasting

Unclassified

Order By: Relevance

“…However, following the recent report that hemodynamics and prognosis can be improved by increasing the hemopuriˆcation level in ICU patients complicated by acute kidney injury, 19) hemopuriˆca-tion under the setting we utilized can no longer be considered to achieve a satisfactory outcome. Ronco et al 19) proposed high-volume hemoˆltration (HVHF) to increase amounts of various solutes (from low-molecular-weight to intermediate-molecular-weight substances).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Doripenem Pharmacokinetics in Critically Ill Patients Receiving Continuous Hemodiafiltration (CHDF)

et al. 2010

View full text Add to dashboard Cite

Objectives of the prospective, open-label study were to investigate pharmacokinetics of doripenem and determine appropriate doripenem regimens during continuous hemodiaˆltration (CHDF) in critically ill patients with renal failure (creatinine clearance ＜30 ml/min) in the intensive care unit at a university hospital in Japan. Six patients received intravenous (IV) administration of 250 mg of doripenem every 12 or 24 hours during CHDF (dialysis rate, 500 ml/h; hemoˆltration rate, 300 ml/h) via a polysulfone hemoˆlter. Doripenem concentrations in pre-and post-membrane blood (plasma) samples collected at speciˆed times during one dosing interval were measured in order to calculate pharmacokinetic parameters and clearance via hemodiaˆltration. Mean half-life (±standard deviation) of doripenem was 7.9±3.7 hours. Total body clearance of doripenem was 58.0±12.7 ml/min, including clearance of 13.5±1.6 ml/min via CHDF. An IV dose of 250 mg of doripenem every 12 hours during CHDF provided adequate plasma concentrations for critically ill patients with renal failure, without resulting in accumulation upon steady-state. Thus, under the conditions tested, CHDF appeared to have little eŠect on doripenem clearance. Therefore, the blood level of doripenem can be satisfactorily controlled by adjustment of doripenem dose and dosing interval, in accordance with residual renal function in patients receiving CHDF.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Ronco et al 19) proposed high-volume hemoˆltration (HVHF) to increase amounts of various solutes (from low-molecular-weight to intermediate-molecular-weight substances). Because doripenem has a low molecular weight and low protein binding, the amount of elimination of doripenem likely will increase as the hemopuriˆcation rate increases.…”

Section: Discussionmentioning

confidence: 99%

Doripenem Pharmacokinetics in Critically Ill Patients Receiving Continuous Hemodiafiltration (CHDF)

et al. 2010

View full text Add to dashboard Cite

show abstract

“…This study presents the methodological approach and clinical testing of a citrate anticoagulation protocol based on an increased continuous veno-venous hemodialysis (CVVHD) dose of 2 liters/h, as recommended for continuous veno-venous hemofiltration (CVVH) by Ronco et al [13]. Taking into account the specific demands of a citrate-based anticoagulation regimen, a new dialysate fluid was composed.…”

Section: Introductionmentioning

confidence: 99%

Regional Citrate Anticoagulation in Continuous Hemodialysis – Acid-Base and Electrolyte Balance at an Increased Dose of Dialysis

Morgera

Haase²,

Rückert³

et al. 2005

Nephron Clin Pract

View full text Add to dashboard Cite

Background: Citrate anticoagulation is an excellent alternative to heparin anticoagulation for patients at high risk of bleeding requiring continuous renal replacement therapy. However, citrate anticoagulation has some potential adverse effects such as metabolic alkalosis and acidosis, hypernatremia, hypo- and hypercalcemia. Thus, most citrate anticoagulation protocols use specially designed dialysis fluids to compensate for most of these disarrangements. This study aimed at establishing a citrate anticoagulation protocol designed for a dialysate flow rate of about 2 l/h. Methods: Based on theoretical considerations we composed a dialysis fluid suitable for a 2 l/h dialysis flow rate. The dialysate contained 133 mmol/l sodium, 2 mmol/l potassium, 1.1 mmol/l magnesium, 25 mmol/l lactate, and 112.2 mmol/l chloride. Results: Twenty-three patients were included in the study. During the treatments minor flow rate adaptations were needed and the treatments were well tolerated. Filter life was appropriate (51.3 ± 24.6 h). Thirteen patients developed a mild metabolic alkalosis (pH > 7.45 plus BE > +3) which was easily counteracted by increasing the dialysis fluid flow (by increments of 500 ml). Acid-base values returned to normal within 24 h after increasing the dialysate flow. The maximum dialysate flow was 3,000 ml/h. Hypernatremia and hypocalcemia were not observed. The systemic ionized calcium concentration was successfully controlled by adjustments of a continuous calcium infusion made with respect to the results of 6-hourly measurements. Conclusion: The analyzed citrate anticoagulation protocol was well tolerated and filter lifetime was appropriate. Regional anticoagulation with trisodium citrate in combination with a customized calcium-free dialysate is a safe and effective alternative to a heparin-based anticoagulation regimen.

show abstract

“…Based on the results of this study, given that a greater amount of doripenem is excreted from the body during high-‰ow CHDF, the daily dose must be increased to 1.0 1.5 g, the same dosage used for patients with C cr ＞50 ml/min. Since 2000, when Ronco C., et al reported that hemodynamics and prognosis improved as a result of increasing the hemopuriˆcation rate, 15) cases in which high-‰ow CHDF is performed to remove various mediators have increased in Japan. In particular, there are sporadic reports of its utility in the acute management of severe sepsis.…”

Section: Discussionmentioning

confidence: 99%

Effect of Hemopurification Rate on Doripenem Pharmacokinetics in Critically Ill Patients Receiving High-flow Continuous Hemodiafiltration

et al. 2011

View full text Add to dashboard Cite

Hemopuriˆcation is an eŠective therapy for acute kidney injury, deˆned as creatinine clearance less than 30 ml/ min, which occurs frequently in the intensive care unit. These critically ill patients often have severe infectious complications and are thus often treated with antibiotics. However, the eŠect of hemopuriˆcation on the pharmacokinetics of antibiotics is not well understood. In this study, we investigated the pharmacokinetics of doripenem (DRPM) in critically ill patients with accompanying renal dysfunction undergoing continuous hemodiaˆltration by high-volumeˆltration/ high-‰ow dialysis (high-‰ow CHDF) and compared it to the pharmacokinetics of DRPM during conventional CHDF. We studied 8 patients (2 in the high-‰ow group and 6 in the conventional group) in whom DRPM was administered while performing CHDF for acute kidney injury. DRPM (250 mg) was intravenously infused over 1 h. For the conventional group, CHDF was performed at a blood ‰ow rate (Q B ) of 100 ml/min, dialysate ‰ow rate (Q D ) of 500 ml/h, and ltration ‰ow rate (Q F ) of 300 ml/h. For the high-‰ow group, CHDF was performed at a blood ‰ow rate (Q B ) of 100 ml/min, dialysate ‰ow rate (Q D ) of 1500 ml/h, andˆltration ‰ow rate (Q F ) of 900 ml/h. For both groups, a polysulfonehemoˆlter with a membrane area of 1.0 m 2 was used. Mean half-life, total body clearance, and clearance via hemodiaˆltration of DRPM were 2.9 h, 118 ml/min, and 41.9 ml/min, respectively, in the high-‰ow group, and 7.9 h, 58 ml/min, and 13.5 ml/min in the conventional group. Clearance via hemodiaˆltration increased approximately 3-fold by tripling the hemopuriˆcation rate. Therefore, CHDF parameters greatly aŠected DRPM pharmacokinetics in patients receiving CHDF. These results suggest that clearance via hemodiaˆltration increases proportionally to the hemopuriˆcation rate. Thus, it is reasonable to conclude that DRPM dose must be increased to 1.0 1.5 g/day when performing high-‰ow CHDF.

show abstract

Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial

Cited by 1,433 publications

References 12 publications

Doripenem Pharmacokinetics in Critically Ill Patients Receiving Continuous Hemodiafiltration (CHDF)

Doripenem Pharmacokinetics in Critically Ill Patients Receiving Continuous Hemodiafiltration (CHDF)

Regional Citrate Anticoagulation in Continuous Hemodialysis – Acid-Base and Electrolyte Balance at an Increased Dose of Dialysis

Effect of Hemopurification Rate on Doripenem Pharmacokinetics in Critically Ill Patients Receiving High-flow Continuous Hemodiafiltration

Contact Info

Product

Resources

About