Assessing and delivering dialysis dose in acute kidney injury (AKI) has emerged as an important issue in the management of critically ill patients. There is ongoing debate on how dose of dialysis should be expressed and measured. Most studies have focused on clearance of small molecules (blood urea nitrogen) as a marker of delivered dose and for establishing dose-outcome relationships. Recent evidence has shown that other markers may also be important to consider, as acid-base balance and fluid overload have emerged as important factors contributing to outcomes. In this review, we provide an evaluation of current approaches to prescribing and delivering dialysis dose in AKI, identify gaps in practice and propose an integrated approach to optimize dose delivery in dialysis with a goal to improve outcomes.
[Show abstract][Hide abstract] ABSTRACT: Acute kidney injury (AKI) is a serious complication in the perioperative period, and is consistently associated with increased rates of mortality and morbidity. Two major consensus definitions have been developed in the last decade that allow for easier comparison of trial evidence. Risk factors have been identified in both cardiac and general surgery and there is an evolving role for novel biomarkers. Despite this, there has been no real change in outcomes and the mainstay of treatment remains preventive with no clear evidence supporting any therapeutic intervention as yet. This review focuses on definition, risk factors, the emerging role of biomarkers and subsequent management of AKI in the perioperative period, taking into account new and emerging strategies.
[Show abstract][Hide abstract] ABSTRACT: Intensity of dialysis dose in acute kidney injury (AKI) might benefit critically ill patients. The aim of this study was to evaluate the effect of intermittent hemodialysis (IHD) dose on mortality in patients with AKI.
Prospective observational study was performed on AKI patients treated with IHD. The delivered dialysis dose per session was calculated based on single-pool Kt/V urea. Patients were allocated in two groups according to the weekly delivered median Kt/V: higher intensity dialysis dose (HID: Kt/V higher than median) and lower intensity dialysis dose (LID: Kt/V lower than median). Thereafter, AKI patients were divided according to the presence or absence of sepsis and urine output. Clinical and lab characteristics and survival of AKI patients were compared.
A total of 121 AKI patients were evaluated. Forty-two patients did not present with sepsis and 45 did not present with oliguria. Mortality rate after 30 days was lower in the HID group without sepsis (14.3% × 47.6%; p = 0.045) and without oliguria (31.8% × 69.5%; p = 0.025). Survival curves also showed that the HID group had higher survival rate when compared with the LID group in non-septic and non-oliguric patients (p = 0.007 and p = 0.003, respectively).
Higher dialysis doses can be associated with better survival of less seriously ill AKI patients.
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