Prevention of intradialytic hypotension in patients with acute kidney injury submitted to sustained low-efficiency dialysis.

OBJECTIVES: This study evaluated the effects of a protocol aiming to reduce hypotension in acute kidney injury (AKI) patients submitted to sustained low-efficiency dialysis (SLED). METHODS: Patients were randomly assigned to two SLED prescriptions-control group, dialysate temperature was 37.0°C with a fixed sodium concentration [138 mEq/L] and ultrafiltration (UF) rate; and profiling group, dialysate temperature was 35.5°C with a variable sodium concentration [150-138 mEq/L] and UF rate. RESULTS: Sixty-two SLED sessions were evaluated (34 in profiling and 28 in control). Patients (n = 31) were similar in terms of gender, age, and Sequential Organ Failure Assessment (SOFA) score. Dialysis time, dialysis dose, and post-dialysis serum sodium were similar in both groups. The profiling group had significantly less hypotension episodes (23% vs. 57% in control, p = 0.009) and achieved higher UF volume (2.23 ± 1.25 L vs. 1.59 ± 1.03 L in control, p = 0.04) when compared with control group. CONCLUSIONS: SLED protocol with modulation of dialysate temperature, sodium, and UF profiling showed similar efficacy but less intradialytic hypotension when compared with a standard SLED prescription.

Avaliação da eficiência dialítica através da quantificação direta do dialisato em pacientes com insuficiência renal aguda submetidos à hemodiálise prolongada / Evaluation of dialysis efficiency by direct dialysate quantificationin acute renal failure patients submitted to extended hemodialysis

Introdução: A melhor forma de quantificar a dose de diálise em pacientes com insuficiência renal aguda (IRA) ainda não está estabelecida. O b j e t i v o s :Avaliar a dose de diálise recebida pela maneira tradicional (PRU e Kt/V) e através da quantificação direta do dialisato em pacientes com IRA. M é t o d o s :A dose de diálise foi quantificada pelo percentual de redução de uréia (PRU), Kt/V (spKt/V e eKt/V) e massa extraída de uréia no dialisato (coleta parcialpor dispositivo automatizado) em pacientes com IRA submetidos à hemodiálise prolongada em unidade de terapia intensiva (UTI). Pacientes cominsuficiência renal crônica (IRC) em programa de diálise serviram como grupo controle. Resultados: Foram realizadas 11 sessões de hemodiáliseprolongada em 8 pacientes com IRA e 8 sessões de hemodiálise convencional em 5 pacientes com IRC. O PRU foi maior nos pacientes com IRC (67%;62-74% v s 54%; 37-57%; P<0,01), assim como o spKt/V (1,31;1,15-1,62 vs 0,90;0,55-1,01; P<0,01) e o eKt/V (1,15; 1,03-1,44 vs 0,69;0,47-0,92; P<0,01).Não houve diferença com relação à massa extraída de uréia no dialisato entre as sessões de hemodiálise convencional (32,6 g; 24,4-56,1) e prolongada(31,8 g; 18,2-88,8). Conclusões: Apesar da maior dose de diálise recebida nos pacientes com IRC, quando avaliada pelo PRU e Kt/V, não houvediferença na massa extraída de uréia no dialisato. Possivelmente, os valores de normalidade definidos pelo método clássico de cinética de uréia parapacientes com IRC não se aplicam a pacientes com IRA e a aferição da dose de diálise pelo dialisato pode ser uma alternativa viável nestes pacientes.

Introduction: The best way for dialysis quantification in patients with acute renal failure (ARF) is not defined. Objectives: Evaluate the delivered dialysisdose by the traditional methods (URR and Kt/V) and by the direct dialysate quantification in patients with acute renal failure. Methods: The dialysis dosewas measured by urea reduction rate (URR), Kt/V (spKt/V, eKt/V) and urea extracted mass in the dialysate (partial dialysate collection by automatic device)in acute renal failure (ARF) patients submitted to extended dialysis in intensive care unit (ICU). Chronic renal failure (CRF) patients were the control group.Results: Eleven extended hemodialysis sessions in eight patients with ARF and eight conventional hemodialysis sessions in five CRF patients wereevaluated. The URR was higher in CRF patients (67%; 62-74% vs 54%; 37-57%; P<0.01) as the spKt/V (1.31;1.15-1.62 vs 0.90;0.55-1.01; P<0.01) andeKt/V (1.15; 1.03-1.44 vs 0.69;0.47-0.92; P<0.01). There was no difference regarding the urea extracted mass in the dialysate in the conventional (32.6 g;24.4-56.1) and extended hemodialysis (31.8 g; 18.2-88.8). Conclusions: In spite of CRF patients have received a higher dialysis dose when evaluated byURR and Kt/V, there was no difference in the urea extracted mass in the dialysate. The classical urea kinetic model may be not applicable for ARF patientsand the evaluation of the dialysate can be an alternative for measurement of dialysis dose in these patients.