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Sustained low efficiency dialysis using a single-pass batch system in acute kidney injury - a randomized interventional trial: the REnal Replacement Therapy Study in Intensive Care Unit PatiEnts

Schwenger, Vedat ; Weigand, Markus A. ; Hoffmann, Oskar ; Dikow, Ralf ; Kihm, Lars P. ; Seckinger, Jörg ; Miftari, Nexhat ; Schaier, Matthias ; Hofer, Stefan ; Haar, Caroline ; Nawroth, Peter Paul ; Zeier, Martin ; Martin, Eike ; Morath, Christian

In: Critical care, 16 (2012), Nr. R140. pp. 1-9. ISSN 1466-609X

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Download (529kB) | Lizenz: Creative Commons LizenzvertragSustained low efficiency dialysis using a single-pass batch system in acute kidney injury - a randomized interventional trial: the REnal Replacement Therapy Study in Intensive Care Unit PatiEnts by Schwenger, Vedat ; Weigand, Markus A. ; Hoffmann, Oskar ; Dikow, Ralf ; Kihm, Lars P. ; Seckinger, Jörg ; Miftari, Nexhat ; Schaier, Matthias ; Hofer, Stefan ; Haar, Caroline ; Nawroth, Peter Paul ; Zeier, Martin ; Martin, Eike ; Morath, Christian underlies the terms of Creative Commons Attribution 3.0 Germany

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Abstract

Introduction: Acute kidney injury (AKI) is associated with a high mortality of up to 60%. The mode of renal replacement therapy (intermittent versus continuous) has no impact on patient survival. Sustained low efficiency dialysis using a single-pass batch dialysis system (SLED-BD) has recently been introduced for the treatment of dialysis-dependent AKI. To date, however, only limited evidence is available in the comparison of SLED-BD versus continuous veno-venous hemofiltration (CVVH) in intensive care unit (ICU) patients with AKI. Methods: Prospective, randomized, interventional, clinical study at a surgical intensive care unit of a university hospital. Between 1 April 2006 and 31 January 2009, 232 AKI patients who underwent renal replacement therapy (RRT) were randomized in the study. Follow-up was assessed until 30 August 2009. Patients were either assigned to 12-h SLED-BD or to 24-h predilutional CVVH. Both therapies were performed at a blood flow of 100 to 120 ml/min. Results: 115 patients were treated with SLED-BD (total number of treatments n = 817) and 117 patients with CVVH (total number of treatments n = 877).The primary outcome measure, 90-day mortality, was similar between groups (SLED: 49.6% vs. CVVH: 55.6%, P = 0.43). Hemodynamic stability did not differ between SLED-BD and CVVH, whereas patients in the SLED-BD group had significantly fewer days of mechanical ventilation (17.7 ± 19.4 vs. 20.9 ± 19.8, P = 0.047) and fewer days in the ICU (19.6 ± 20.1 vs. 23.7 ± 21.9, P = 0.04). Patients treated with SLED needed fewer blood transfusions (1,375 ± 2,573 ml vs. 1,976 ± 3,316 ml, P = 0.02) and had a substantial reduction in nursing time spent for renal replacement therapy (P < 0.001) resulting in lower costs. Conclusions: SLED-BD was associated with reduced nursing time and lower costs compared to CVVH at similar outcomes. In the light of limited health care resources, SLED-BD offers an attractive alternative for the treatment of AKI in ICU patients. Trial registration: ClinicalTrials.gov NCT00322530

Item Type: Article
Journal or Publication Title: Critical care
Volume: 16
Number: R140
Publisher: BioMed Central; Springer
Place of Publication: London; Berlin; Heidelberg
Date Deposited: 18 Aug 2016 13:20
Date: 2012
ISSN: 1466-609X
Page Range: pp. 1-9
Faculties / Institutes: Service facilities > Nierenzentrum Heidelberg
Medizinische Fakultät Heidelberg > Medizinische Universitäts-Klinik und Poliklinik
Medizinische Fakultät Heidelberg > Universitätsklinik für Anaesthesiologie
Subjects: 610 Medical sciences Medicine
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