Extended Daily Dialysis vs. Continuous Hemodialysis for ICU Patients with Acute Renal Failure: A Two-Year Single Center Report

Abstract

Extended daily dialysis (EDD) is an easily implemented alternative to continuous renal replacement therapy (CRRT) in the intensive care unit (ICU). Since EDD offers most of the advantages of CRRT, we sought to compare the effectiveness of these two modalities. In this 2-year study, 54 ICU patients with ARF were treated with either continuous hemodialysis (CHD) or EDD. Oliguria was present in 64% of patients who received CHD vs. 73% of EDD patients (p=NS) while 93% of CHD and 81% of EDD patients required mechanical ventilation (p=NS). Patients treated with EDD were younger than those who received CHD (47.0 ± 12.6 vs. 56.7 ± 13.7, p=0.009), but there were no significant differences in gender or mean APACHE II scores at the time of randomization. Mean arterial blood pressures measured during treatment were maintained between 70 and 80 mmHg for both EDD and CHD and average daily serum electrolyte levels fell within normal ranges for EDD and CHD. Average daily fluid input and output were 5.8 ± 3.3L and 6.0 ± 3.2 L for CHD vs. 3.3 ± 2.6 and 3.0 ± 1.7 L for EDD after exclusion of data from 2 burn patients. Hourly heparin anticoagulation rates were 1080 U/hour for CHD and 643 U/hour for EDD, p=0.02. Anticoagulation-free treatments were performed during 43% of all EDD treatments vs. 21% of all CHD treatments, p<0.001. Clotting of the dialyzer or circuit occurred at least once during 51% of all CHD treatment days vs. 22% of EDD treatments (p<0.001). We conclude that EDD is a safe, effective alternative to CRRT that offers comparable hemodynamic stability and excellent small solute control.

Pharmacokinetics of linezolid in septic patients with and without extended dialysis

“…In intensive care patients suffering from sepsis and multiple organ failure, extended dialysis is an important supportive extracorporeal renal replacement therapy. Despite the increasing use of extended dialysis in the intensive care unit (ICU) throughout Europe and the USA [1][2][3][4][5][6][7], little data are available on the effect of this highly efficient renal replacement therapy on the elimination of frequently used drugs in critically ill patients. Antimicrobial agents are among the most commonly prescribed drugs in this population.…”

Pharmacokinetics of Moxifloxacin and Levofloxacin in Intensive Care Unit Patients Who Have Acute Renal Failure and Undergo Extended Daily Dialysis

“…In intensive care unit (ICU) patients who have sepsis and multiple organ failure, extended daily dialysis (EDD) represents an important extracorporeal renal replacement therapy that is increasingly used in ICU throughout Europe, the United States, and Brazil (2)(3)(4)(5)(6)(7)(8). EDD could remove drugs to a much different degree compared with standard intermittent hemodialysis (IHD) three times a week or continuous renal replacement therapy (CRRT) (9).…”

Choice of Renal Replacement Therapy and Role of Haemodialysis in the Intensive Care Unit

“…This observation makes intermittent HD less suitable for patients with major fluid overload and supports the recommendation to use continuous RRT for this patient group (Vanholder et al, 2011). Comparative studies of continuous and hybrid techniques are limited (Abe et al, 2010;Kielstein et al, 2004;Kumar et al, 2000;Kumar et al, 2004;Marshall et al, 2004). In a small trial, 39 patients were randomised to either CVVHF or 12-hour SLED (Kielstein et al, 2004).…”