The Change in Renal Replacement Therapy on Acute Renal Failure in a General Intensive Care Unit in a University Hospital and its Clinical Efficacy: A Japanese Experience

Hirayama, Yoh; Hirasawa, Hiroyuki; Oda, Shigeto; Shiga, Hidetoshi; Nakanishi, Koji; Matsuda, Kazuo; Nakamura, Masataka; Hirano, Takeshi; Moriguchi, Takeshi; Watanabe, Eizo; Nitta, Masakazu; Abe, Ryuzo; Nakada, Taka‐aki

doi:10.1046/j.1526-0968.2003.00094.x

Cited by 16 publications

(4 citation statements)

References 38 publications

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“…Therefore, when hypercytokinemia is suspected in critically ill patients with AKI with symptoms of high fever and low blood pressure prior to treatment, the use of PMMA membrane might be beneficial. Our results indicated that in RRT, the selection of an appropriate hemofilter is also crucial for modulating humoral mediators, because the efficacy of cytokine removal depends on the type of hemofilter used; this has also been indicated by several other researchers (25–27).…”

Section: Discussionsupporting

confidence: 68%

Comparison of Sustained Hemodiafiltration With Continuous Venovenous Hemodiafiltration for the Treatment of Critically Ill Patients With Acute Kidney Injury

et al. 2010

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Despite improvements in medical care, the mortality of critically ill patients with acute kidney injury (AKI) who require renal replacement therapy (RRT) remains high. We describe a new approach, sustained hemodiafiltration, to treat patients who suffered from acute kidney injury and were admitted to intensive care units (ICUs). In our study, 60 critically ill patients with AKI who required RRT were treated with either continuous venovenous hemodiafiltration (CVVHDF) or sustained hemodiafiltration (S-HDF). The former was performed by administering a postfilter replacement fluid at an effluent rate of 35 mL/kg/h, and the latter was performed by administering a postfilter replacement fluid at a dialysate-flow rate of 300-500 mL/min. The S-HDF was delivered on a daily basis. The baseline characteristics of the patients in the two treatment groups were similar. The primary study outcome--survival until discharge from the ICU or survival for 30 days, whichever was earlier--did not significantly differ between the two groups: 70% after CVVHDF and 87% after S-HDF. The hospital-survival rate after CVVHDF was 63% and that after S-HDF was 83% (P < 0.05). The number of patients who showed renal recovery at the time of discharge from the ICU and the hospital and the duration of the ICU stay significantly differed between the two treatments (P < 0.05). Although there was no significant difference between the mean number of treatments performed per patient, the mean duration of daily treatment in the S-HDF group was 6.5 +/- 1.0 h, which was significantly shorter. Although the total convective volumes--the sum of the replacement-fluid and fluid-removal volumes--did not differ significantly, the dialysate-flow rate was higher in the S-HDF group. Our results suggest that in comparison with conventional continuous RRT, including high-dose CVVHDF, more intensive renal support in the form of postdilution S-HDF will decrease the mortality and accelerate renal recovery in critically ill patients with AKI.

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Section: Discussionsupporting

confidence: 68%

Comparison of Sustained Hemodiafiltration With Continuous Venovenous Hemodiafiltration for the Treatment of Critically Ill Patients With Acute Kidney Injury

et al. 2010

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“…These factors include advanced age, male gender, prolonged hospital stay, hepatic or biliary tract diseases, prolonged prothrombin time, hypotension, metabolic acidosis, sepsis, coma, need of vasoactive drugs, respiratory distress or need for mechanical ventilation, need for dialysis, use of vasoactive drugs, high levels of serum creatinine, oliguria and delayed consultation by the nephrologists [3][4][5][6][7][8][9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Comparison between early and delayed acute kidney injury secondary to infectious disease in the intensive care unit

et al. 2008

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“…10 Over the past years, several studies have been performed with the aim of identifying prognostic factors and predicting the outcomes for critically ill patients with ARF admitted to intensive care units (ICUs). 7,[10][11][12][13] The risk factors for death identifi ed in previous studies were advanced age, male gender, prolonged hospital stay, hepatic or biliary tract diseases, hematological dysfunction, hypotension, shock, coma, need for vasoactive drugs, respiratory distress or need for mechanical ventilation, sepsis, need for dialytic treatment, high levels of creatinine, oliguria and delayed consultation with a nephrologist. 6,8,11,12,[14][15][16] Better knowledge of factors associated with a bad prognosis in ARF cases is very important for improving prevention and treatment, especially among critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

“…4,6,[8][9][10][11][12][13][14][15][16] The present study had the aim of investigating the risk factors for death among critically ill patients with ARF admitted to an ICU in northeastern Brazil. Knowledge of these factors will be important for adopting preventive measures and more adequate treatment that could decrease mortality rates.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for death among critically ill patients with acute renal failure

et al. 2006

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CONTEXT AND OBJECTIVE: Acute renal failure is a common medical problem, with a high mortality rate. The aim of this work was to investigate the risk factors for death among critically ill patients with acute renal failure. DESIGN AND SETTING: Retrospective cohort at the intensive care unit of Hospital Universitário Walter Cantídio, Fortaleza. METHODS: Survivors and non-survivors were compared. Univariate and multivariate analyses were performed to establish risk factors for death. RESULTS: Acute renal failure occurred in 128 patients (33.5%), with mean age of 49 ± 20 years (79 males; 62%). Death occurred in 80 (62.5%). The risk factors most frequently associated with death were hypotension, sepsis, nephrotoxic drug use, respiratory insufficiency, liver failure, hypovolemia, septic shock, multiple organ dysfunction, need for vasoactive drugs, need for mechanical ventilation, oliguria, hypoalbuminemia, metabolic acidosis and anemia. There were negative correlations between death and: prothrombin time, hematocrit, hemoglobin, systolic blood pressure, diastolic blood pressure, arterial pH, arterial bicarbonate and urine volume. From multivariate analysis, the independent risk factors for death were: need for mechanical ventilation (OR = 3.15; p = 0.03), hypotension (OR = 3.48; p = 0.02), liver failure (OR = 5.37; p = 0.02), low arterial bicarbonate (OR = 0.85; p = 0.005), oliguria (OR = 3.36; p = 0.009), vasopressor use (OR = 4.83; p = 0.004) and sepsis (OR = 6.14; p = 0.003). CONCLUSIONS: There are significant risk factors for death among patients with acute renal failure in intensive care units, which need to be identified at an early stage for early treatment.

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The Change in Renal Replacement Therapy on Acute Renal Failure in a General Intensive Care Unit in a University Hospital and its Clinical Efficacy: A Japanese Experience

Cited by 16 publications

References 38 publications

Comparison of Sustained Hemodiafiltration With Continuous Venovenous Hemodiafiltration for the Treatment of Critically Ill Patients With Acute Kidney Injury

Comparison of Sustained Hemodiafiltration With Continuous Venovenous Hemodiafiltration for the Treatment of Critically Ill Patients With Acute Kidney Injury

Comparison between early and delayed acute kidney injury secondary to infectious disease in the intensive care unit

Risk factors for death among critically ill patients with acute renal failure

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