Extended daily dialysis: A new approach to renal replacement for acute renal failure in the intensive care unit

Regional Citrate Anticoagulation for RRTs in Critically Ill Patients with AKI

“…Saline flushes without a antihemostatic agent (81,83,84), unfractioned heparin (79,81,83,85), or prostacyclin (80) are among the different options proposed thus far for the maintenance of the extracorporeal PIRRT circuit. Treatment interruption because of circuit clotting is found in 26%-46% of cases with saline flushes and 17%-26% of cases with standard heparin (500-1000 IU/h) (81,83,84). A 10% incidence of circuit interruption (one half for circuit coagulation) has been reported when relatively low doses of epoprostenol, a synthetic analog of the antiaggregant and vasodilatory prostacyclin PGI 2 , are used (80).…”

Renal replacement therapy review

“…An early publication in 2000 described EDD with a Qb 200 ml/min, Qd 300 ml/min over 6-8 hours with improved urea clearance as compared to continuous hemofiltration. 89 Although not published until 2001, SLED experience began in 1998 at a single institution and demonstrated a Kt/V 1.36 delivered over 10 hours with Qb 200 ml/min and Qd 100 ml/min. 90 In both these publications, the therapy was hemodynamically tolerated, and an adequate dose of therapy was delivered.…”

Prevention and Treatment of Acute Renal Failure in Sepsis

“…In contrast, a randomized trial in 106 severely ill ventilated and oliguric patients found no difference in time to renal recovery or 28-d mortality between early started HVHF (48.2 ml/h per kg), early-started low-volume hemofiltration (20.1 ml/h per kg), and latestarted low-volume hemofiltration (19.0 ml/h per kg) (124). EDD is a hybrid technique, designed to combine the theoretical advantages of IHD (flexibility of the dialysate composition, patient mobility, low cost) and of CRRT (better hemodynamic tolerance) (125)(126)(127). Dialysis with standard IHD equipment is performed daily over an extended treatment time, using low dialysate and blood flow rates.…”

“…Dialysis with standard IHD equipment is performed daily over an extended treatment time, using low dialysate and blood flow rates. Preliminary experience has been promising (125)(126)(127), but the technique has not been prospectively compared with other renal replacement modalities. In conclusion, HVHF and EDD should be subject to the same criteria for acceptance as any new technique or agent seeking approval for clinical use, that is a randomized controlled comparison with standard techniques.…”