Mortality and Recovery of Renal Function in Acute Kidney Injury Patients Treated with Prolonged Intermittent Hemodialysis Sessions Lasting 10 versus 6 Hours: Results of a Randomized Clinical Trial.

Bianca Ballarin Albino,Daniela Ponce,André Luís Balbi,Mariele Gobo-Oliveira

doi:10.1155/2018/4097864

Bianca Ballarin Albino, Daniela Ponce + Show 2 more

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https://doi.org/10.1155/2018/4097864

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Abstract

Purpose This trial aimed to compare mortality and recovery of renal function in acute kidney injury (AKI) patients treated with different durations of prolonged hemodialysis (PHD) sessions (6 h versus 10 h). Methodology We included patients with sepsis-associated AKI, >18 years, who are in use of a norepinephrine (lower than 0.7 ucg/kg/min). Results One hundred and ninety-four patients were treated with 531 sessions of PHD (G1=104 and G2=90 patients). The two groups were similar in age and SOFA. There was no significant difference in hypotension, hypokalemia, and anticoagulation during PHD sessions. The two groups showed differences in filter clotting, hypophosphatemia, and treatment discontinuation (12.3 versus 23.1%, p=0.002; 15.5 versus 25.8%, p=0.005; and 7.9 versus 15.6%, p=0.008, respectively). There was no difference in fluid balance (FB) before and after PHD sessions. Death and complete recovery of renal function were similar (81.3 versus 82.2%, p=0.87 and 21 versus 31.2%, p=0.7, respectively). At logistic regression, the positive FB before and after dialysis was identified as risk factor for death, while volume overload after three PHD sessions and predialysis creatinine were negatively associated with recovery of renal function in 28 days. Conclusion There was no difference in the mortality and recovery of renal function of AKI patients submitted to different durations of PHD and sessions lasting 10 h presented higher filter clotting, hypophosphatemia, and treatment discontinuation. ISRCTN Registry number is ISRCTN33774458.

Highlights

Acute kidney injury (AKI) is a complex and frequent syndrome in septic patients admitted to intensive care units (34%)
Peritoneal dialysis (PD) and hemodialysis (HD) are options for acute kidney injury support. Depending on their duration and flow of blood and dialysate they can be classified as conventional intermittent hemodialysis (IHD), prolonged intermittent hemodialysis (PHD), and continuous renal replacement therapy (CRRT) [6, 7]
PHD consists of a hybrid method with IHD characteristics, such as the use of machines and filters similar to those used in the treatment of chronic dialysis patients

Summary

Introduction

Acute kidney injury (AKI) is a complex and frequent syndrome in septic patients admitted to intensive care units (34%). Peritoneal dialysis (PD) and hemodialysis (HD) are options for acute kidney injury support Depending on their duration and flow of blood and dialysate they can be classified as conventional intermittent hemodialysis (IHD), prolonged intermittent hemodialysis (PHD), and continuous renal replacement therapy (CRRT) [6, 7]. PHD consists of a hybrid method with IHD characteristics, such as the use of machines and filters similar to those used in the treatment of chronic dialysis patients It has CRRT characteristics, such as smaller flow of blood and dialysate, between 70-250 ml/min and 70-300 ml/min, respectively [8,9,10]. At the moment the literature does not include any studies that have evaluated and compared mortality rates and recovery of renal function in patients with AKI treated with PHD sessions of different durations. We hypothesized that PHD sessions lasting 10 hours would cause less hypotension than PHD sessions lasting 6 hours, leading to faster partial recovery of renal function

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