Urea Kinetics, Efficiency, and Adequacy of Hemodialysis and Other Intermittent Treatments

Niti Madan, Jane Y Yeun, Thomas A. Depner

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

In the setting of renal failure, hemodialysis is an extremely effective therapy that has an impressive potential for preserving life despite total loss of a vital organ. It is clear that the average intensive care unit patient treated with intermittent hemodialysis three times weekly receives less hemodialysis than the average outpatient, despite the need for more dialysis to manage the high rates of catabolism often found in critically ill patients.This chapter focuses on hemodialysis: more specifically, on the dose of dialysis and its adequacy in critically ill patients requiring intensive care. It reviews various methods to measure and improve the adequacy of renal replacement therapy in the intensive care unit.The primary responsibility of clinicians managing the patient with acute kidney injury is to ensure adequate removal of toxic small solutes. Each patient is different, so the clinician must tailor renal replacement therapy to the individual patient's needs, making adjustments in the timing, frequency, duration, flow rates, and other parameters to fit. Increasing the frequency of intermittent renal replacement therapy theoretically raises its ceiling of effectiveness, and extending treatment time may add further benefit.It is possible that differences in the dialysis modality (intermittent hemodialysis vs. continuous renal replacement therapy) as well as variations in the timing of initiation and/or dosing may affect renal recovery and survival, but all major trials fail to show that. The good news is that in acute kidney injury recovery is possible and that near-normal kidney function after recovery is a strong possibility.

Original languageEnglish (US)
Title of host publicationCritical Care Nephrology
Subtitle of host publicationThird Edition
PublisherElsevier Inc.
Pages947-955.e2
ISBN (Electronic)9780323449427
ISBN (Print)9780323449427
DOIs
StatePublished - Dec 6 2017

Keywords

  • Dialysis adequacy in critically ill ICU patients
  • Dialysis dosing in ICU patients
  • Ionic dialysance (on-line measurement of adequacy)
  • Limitations of Kt/V
  • Standard Kt/V

ASJC Scopus subject areas

  • Medicine(all)

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