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Rinaldo Bellomo - One of the best experts on this subject based on the ideXlab platform.
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A pilot randomized controlled comparison of Extended Daily Dialysis with filtration and continuous veno-venous hemofiltration: fluid removal and hemodynamics.
International Journal of Artificial Organs, 2020Co-Authors: Ian T. Baldwin, Rinaldo Bellomo, Toshio Naka, Bill Koch, Nigel FealyAbstract:OBJECTIVES: Extended intermittent dialytic techniques are increasingly being reported in the treatment of ARF in the ICU but few randomized controlled trials exist. We compared one such technique to a technique of continuous renal replacement therapy with regard to fluid removal and hemodynamics. METHODS: Sixteen critically ill patients with ARF were enrolled in a randomized controlled trial at the ICU of a tertiary hospital. We randomized eight patients to three consecutive days of treatment with either Extended Daily Dialysis with filtration (EDDf) or Continuous Veno-Venous Hemofiltration (CVVH) and compared fluid removal and hemodynamics during treatment. RESULTS: A total of 16.6 liters of fluid were removed during EDDf (830 mL/day over 20 treatment days) compared with 15.4 liters (700 ml/day over 22 treatment days) during CVVH. Median fluid removal per day was 1837 mL in the EDDf group compared with 1410 mL per day in the CVVH group, p=0.674. Median hourly fluid removal rate was 252 mL for EDDf and 128 mL for CVVH (p
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Extended Daily Dialysis versus continuous renal replacement therapy for acute kidney injury a meta analysis
American Journal of Kidney Diseases, 2015Co-Authors: Ling Zhang, Jiqiao Yang, Glenn M Eastwood, Aiko Tanaka, Rinaldo BellomoAbstract:BACKGROUND: Extended Daily Dialysis (EDD) has been suggested as an effective renal replacement therapy for acute kidney injury. However, results from studies comparing EDD to continuous renal replacement therapy (CRRT) are inconclusive. STUDY DESIGN: A systematic review and meta-analysis was performed by searching in MEDLINE, EMBASE, the Cochrane Library, Google Scholar, and a Chinese database (SinsoMed). SETTING & POPULATION: Patients with acute kidney injury. SELECTION CRITERIA FOR STUDIES: Randomized controlled trials (RCTs) and observational studies were included. EDD was defined as Extended hemoDialysis or hemodiafiltration for more than 6 but less than 24 hours per session using a conventional hemoDialysis machine. INTERVENTION: Renal replacement therapy comparing EDD with CRRT. OUTCOMES: Mortality, kidney recovery, and fluid removal. RESULTS: We included 17 studies from 2000 to 2014: 7 RCTs and 10 observational studies involving 533 and 675 patients, respectively. Meta-analysis of RCTs showed no difference in mortality rates between EDD and CRRT (relative risk, 0.90; 95% CI, 0.74-1.11; P=0.3). However, EDD was associated with lower mortality risk compared with CRRT in observational studies (relative risk, 0.86; 95% CI, 0.74-1.00; P=0.05). There was no evidence of heterogeneity in RCTs (I(2)=0%) or observational studies (I(2)=15%). In both RCTs and observational studies, there were no significant differences in recovery of kidney function, fluid removal, or days in the intensive care unit, and EDD showed similar biochemical efficacy to CRRT during treatment (serum urea, serum creatinine, and serum phosphate). LIMITATIONS: The survival benefit of EDD is dependent on only observational studies and might have been affected by allocation or selection bias. CONCLUSIONS: EDD is associated with similar outcomes to CRRT in RCTs. The finding that EDD is associated with a lower mortality rate relies on data from observational studies, which are potentially subject to allocation or selection bias, making further high-quality RCTs desirable.
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original investigation Extended Daily Dialysis versus continuous renal replacement therapy for acute kidney injury a meta analysis
2015Co-Authors: Ling Zhang, Jiqiao Yang, Glenn M Eastwood, Aiko Tanaka, Rinaldo BellomoAbstract:Background: Extended Daily Dialysis (EDD) has been suggested as an effective renal replacement therapy for acute kidney injury. However, results from studies comparing EDD to continuous renal replacement therapy (CRRT) are inconclusive. Study Design: A systematic review and meta-analysis was performed by searching in MEDLINE, EMBASE, the Cochrane Library, Google Scholar, and a Chinese database (SinsoMed). Setting & Population: Patients with acute kidney injury. Selection Criteria for Studies: Randomized controlled trials (RCTs) and observational studies were included. EDD was defined as Extended hemoDialysis or hemodiafiltration for more than 6 but less than 24 hours per session using a conventional hemoDialysis machine. Intervention: Renal replacement therapy comparing EDD with CRRT. Outcomes: Mortality, kidney recovery, and fluid removal. Results: We included 17 studies from 2000 to 2014: 7 RCTs and 10 observational studies involving 533 and 675 patients, respectively. Meta-analysis of RCTs showed no difference in mortality rates between EDD and CRRT (relative risk, 0.90; 95% CI, 0.74-1.11; P 5 0.3). However, EDD was associated with lower mortality risk compared with CRRT in observational studies (relative risk, 0.86; 95% CI, 0.74-1.00; P 5 0.05). There was no evidence of heterogeneity in RCTs (I 2 5 0%) or observational studies (I 2 5 15%). In both RCTs and observational studies, there were no significant differences in recovery of kidney function, fluid removal, or days in the intensive care unit, and EDD showed similar biochemical efficacy to CRRT during treatment (serum urea, serum creatinine, and serum phosphate). Limitations: The survival benefit of EDD is dependent on only observational studies and might have been affected by allocation or selection bias. Conclusions: EDD is associated with similar outcomes to CRRT in RCTs. The finding that EDD is associated with a lower mortality rate relies on data from observational studies, which are potentially subject to allocation or selection bias, making further high-quality RCTs desirable. Am J Kidney Dis. 66(2):322-330. a 2015 by the National Kidney Foundation, Inc.
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a pilot randomized controlled comparison of Extended Daily Dialysis with filtration and continuous veno venous hemofiltration fluid removal and hemodynamics
International Journal of Artificial Organs, 2007Co-Authors: Ian T. Baldwin, Rinaldo Bellomo, Toshio Naka, Bill Koch, Nigel FealyAbstract:OBJECTIVES: Extended intermittent dialytic techniques are increasingly being reported in the treatment of ARF in the ICU but few randomized controlled trials exist. We compared one such technique to a technique of continuous renal replacement therapy with regard to fluid removal and hemodynamics. METHODS: Sixteen critically ill patients with ARF were enrolled in a randomized controlled trial at the ICU of a tertiary hospital. We randomized eight patients to three consecutive days of treatment with either Extended Daily Dialysis with filtration (EDDf) or Continuous Veno-Venous Hemofiltration (CVVH) and compared fluid removal and hemodynamics during treatment. RESULTS: A total of 16.6 liters of fluid were removed during EDDf (830 mL/day over 20 treatment days) compared with 15.4 liters (700 ml/day over 22 treatment days) during CVVH. Median fluid removal per day was 1837 mL in the EDDf group compared with 1410 mL per day in the CVVH group, p=0.674. Median hourly fluid removal rate was 252 mL for EDDf and 128 mL for CVVH (p<0.01). Mean arterial pressure in the EDDf group was lower at two hours after starting treatment (76 mmHg vs. 94 mmHg) in the CVVH group; p= 0.031. There was no significant difference between groups for heart rate, CVP and noradrenaline dose at all time intervals measured. CONCLUSIONS: Adequate prescribed fluid removal was achieved with both techniques. However, as expected, fluid was removed at a faster rate during EDDf. This was initially associated with a lower blood pressure than during CVVH where blood pressure increased.
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A pilot randomised controlled comparison of continuous veno–venous haemofiltration and Extended Daily Dialysis with filtration: effect on small solutes and acid–base balance
Intensive Care Medicine, 2007Co-Authors: Ian Baldwin, Bill Koch, Toshio Naka, Nigel Fealy, Rinaldo BellomoAbstract:Background and aims Continuous veno–venous haemofiltration (CVVH) is an established treatment for acute renal failure (ARF). Recently, Extended intermittent dialytic techniques have been proposed for the treatment of ARF. The aim of this study was to compare these two approaches. Setting Intensive care unit of tertiary hospital. Subjects Sixteen critically ill patients with ARF. Design Randomised controlled trial. Intervention We randomised sixteen patients to three consecutive days of treatment with either CVVH (8) or Extended Daily Dialysis with filtration (EDDf) (8) and compared small-solute, electrolyte and acid–base control. Results There was no significant difference between the two therapies for urea or creatinine levels over 3 days. Of 80 electrolyte measurements taken before treatment, 19 were abnormal. All values were corrected as a result of treatment, except for one patient in the CVVH group who developed hypophosphataemia (0.54 mmol/l) at 72 h. After 3 days of treatment, there was a mild but persistent metabolic acidosis in the EDDf group compared to the CVVH group (median bicarbonate: 20 mmol/l vs. 29 mmol/l: p = 0.039; median base deficit: –4 mEq/l vs. –2.1 mEq/l, p = 0.033). Conclusions CVVH and EDDf as prescribed achieved similar control of urea, creatinine and electrolytes. Acidosis was better controlled with CVVH.
Jan T Kielstein - One of the best experts on this subject based on the ideXlab platform.
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Research Circulating angiopoietin-1 and angiopoietin-2 in critically ill patients: development and clinical application of two new
2020Co-Authors: Julian Hellpap, R. Horn, Sascha David, Jan T Kielstein, Hermann Haller, Philipp KümpersAbstract:Introduction In critically ill patients, the massive release of angiopoietin-2 (Ang-2) from endothelial Weibel–Palade bodies interferes with constitutive angiopoietin-1 (Ang-1)/Tie2 signaling in endothelial cells, thus leading to vascular barrier breakdown followed by leukocyte transmigration and capillary leakage. The use of circulating Ang-1 and Ang-2 as novel biomarkers of endothelial integrity has therefore gained much attention. The preclinical characteristics and clinical applicability of angiopoietin immunoassays, however, remain elusive. Methods We developed sandwich immunoassays for human Ang-1 (immunoradiometric sandwich assay/ immunoluminometric sandwich assay) and Ang-2 (ELISA), assessed preanalytic characteristics, and determined circulating Ang-1 and Ang-2 concentrations in 30 healthy control individuals and in 94 critically ill patients. In addition, Ang-1 and Ang-2 concentrations were measured in 10 patients during a 24-hour time course with respect to interference by intravenous antibiotic treatment and by Extended Daily Dialysis. Results The assays had detection limits of 0.12 ng/ml (Ang-1) and 0.2 ng/ml (Ang-2). Inter-assay and intra-assay imprecision was ≤8.8% and 3.7% for Ang-1 and was ≤4.6% and 5.2% for Ang-2, respectively. Angiopoietins were stable for 24 hours and were resistant to four freeze–thaw cycles. Angiopoietin concentrations were not associated with age, body mass index or renal function in healthy individuals. Ang-1 and Ang-2 concentrations correlated with severity of illness in critically ill patients. Angiopoietin concentrations were not influenced by antibiotic treatment or by Extended Daily Dialysis.
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single and multiple dose pharmacokinetics of ethambutol and rifampicin in a tuberculosis patient with acute respiratory distress syndrome undergoing Extended Daily Dialysis and ecmo treatment
International Journal of Infectious Diseases, 2016Co-Authors: Annkathrin Strunk, Tobias Welte, Julius J Schmidt, Marius M. Hoeper, Sandra Ciesek, C Kuhn, Jan T KielsteinAbstract:Summary The dosing of drugs in critically ill patients undergoing renal replacement therapy is based on limited data. We report for the first time single- and multiple-dose pharmacokinetics of ethambutol (EMB), which is cleared renally to 80%, and rifampicin (RIF), which is cleared renally to
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single and multiple dose pharmacokinetics and total removal of colistin in a patient with acute kidney injury undergoing Extended Daily Dialysis
Journal of Antimicrobial Chemotherapy, 2014Co-Authors: Annkathrin Strunk, Tobias Welte, Stefanie M Bodeboger, Julius J Schmidt, Eva Baroke, Jens Martenslobenhoffer, Jan T KielsteinAbstract:Sir, The emergence of multidrug-resistant bacteria has recently renewed interest in colistin, which was first introduced in 1959. For intravenous administration, not colistin itself, but its inactive prodrug colistin methanesulfonate (CMS) is administered. As 70% of CMS is excreted unchanged in the urine, its t1 2 increases with a decline in glomerular filtration rate (GFR) to up to 14 h in patients with a GFR ,15 mL/min. Additionally, a larger fraction of the CMS dose is converted into colistin with decreasing renal function. Thus, dose reduction is recommended with decreasing GFR. Data from 1968 on four patients treated with twice-weekly Dialysis for 11–16 h using a cuprophane membrane are the foundation for current dosing regimens in chronic haemoDialysis. In these patients a dose of 1 million units every 48 h is recommended. Data on dosing in critically ill patients undergoing Extended Dialysis are missing. We here report for the first time, singleand multiple-dose pharmacokinetics of colistin in a critically ill patient undergoing Extended Dialysis. Written informed consent was obtained from the patient’s mother for publication of this study. Ethical approval for reporting this case was obtained from the Medical School Hannover. A patient aged between 30 and 40 years (height 163 cm, weight 53 kg) was admitted to our intensive care unit (ICU) for rapidly progressive respiratory failure. The patient had undergone lung transplantation for pulmonary hypertension 10 months earlier. The patient’s post-transplant course had been complicated by acute rejection and an Aspergillus fumigatus infection. On admission, the patient required non-invasive ventilation. Bronchoalveolar lavage revealed a multiresistant Klebsiella pneumoniae in addition to the previously known Aspergillus. Endotracheal intubation was required owing to worsening respiratory failure. Extended Dialysis for acute kidney injury was started. As the K. pneumoniae was only susceptible to colistin, we initiated treatment with 3 million units every 8 h after an initial dose of 6 million units. Blood samples were taken at regular intervals on day 1 and day 9 of treatment. Colistin and CMS concentrations were determined separately by HPLC combined with tandem mass spectrometry, as recently used in its modified form. The average Dialysis time between day 1 and day 9 was 552 min; mean blood and dialysate flow were 191 mL/min and 121 mL/ min, respectively. After a loading dose of 6 million units, peak levels of colistin and CMS were 10.01 mg/mL and 24.76 mg/mL, respectively. The lowest plasma concentrations on day 1 were 3.83 mg/mL for colistin and ,0.1 mg/mL for CMS. Extended Dialysis with the above-mentioned specifications led to a reduction of peak colistin levels (Figure 1). After 9 days of treatment with 3 million units every 8 h there was neither an accumulation of colistin (peak level day 9: 8.96 mg/mL, trough level 2.13 mg/mL) nor an accumulation of CMS (peak level day 9: 11.83 mg/mL, trough level ,0.1 mg/mL). Depending on the blood and dialysate flow, the dialyser clearance of colistin ranged between 54 and 71 mL/min and the CMS clearance between 25 and 62 mL/min. The amount of colistin in the total collected dialysate was 245 mg on day 1 and 191 mg on day 9. Although the patient responded well to this antibiotic therapy, subsequent cerebral aspergillosis could not be treated, leading to the death of the patient after 5 weeks of treatment in the ICU. There are scarce data on the dosing of antibiotics in patients undergoing renal replacement therapy. Our data suggest that Extended Dialysis eliminates colistin effectively and to a larger extent than regular intermittent outpatient haemoDialysis. This is in line with recent data on two critically ill patients undergoing a modern type of intermittent Dialysis (1.6 m polymethylacrylate membrane, blood/dialysate flow 300/500 mL/min, duration 4 h), in whom a CMS dialyser clearance of 90 mL/min was reported. Li et al. described a dialyser clearance of 11.9 mL/min for colistin and 11.2 mL/min for CMS in one critically ill patient undergoing continuous venovenous haemodiafiltration, which due to its continuous mode would remove approximately the same amount of the drug. Lastly, dialyser clearance in five patients receiving continuous venovenous haemodiafiltration was recently reported to be 72 mL/min for colistin and 32 mL/min for CMS. Thus, dosing colistin as recommended during regular haemoDialysis is inadequate and would result in a significant under-dosing, which could be associated with a substantial risk, especially in critically ill patients in the ICU. A dose of 3 million units every 8 h seems to be adequate for patients undergoing Daily Extended Dialysis for 9 h a day with a high flux 1.3 m dialyser. This dose of 9 million units per day did not lead to accumulation of the drug.
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Extended Daily Dialysis
2010Co-Authors: Danilo Fliser, Jan T KielsteinAbstract:Key elements defining a renal replacement therapy as Extended Daily Dialysis (EDD) are Extended Dialysis time (usually 8–18 h) and slow dialysate and blood flow rates. Prospective controlled studies in critically ill patients have documented that small solute clearance with EDD is comparable with that of intermittent hemoDialysis (IHD) and continuous venovenous hemofiltration (CVVH). Patient’s cardiovascular stability during EDD is similar to continuous renal replacement therapy (CRRT). Nightly EDD treatments have the added benefit of unrestricted access of intensive care unit (ICU) staff to the patient during the day, minimizing interference of renal replacement therapy with other ICU activities. EDD combines several advantages of both intermittent and continuous techniques
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Failed rescue therapy with rapamycin after paraquat intoxication.
Clinical Toxicology, 2009Co-Authors: Johan M Lorenzen, Carsten Hafer, Eva Schonenberger, Marius M. Hoeper, Jan T KielsteinAbstract:Introduction. Ingestion of large quantities of paraquat leads to irreversible, often fatal pulmonary fibrosis. Case presentation. A 50-year-old man (body weight of 78.6 kg) ingested 500 mL Gramoxone® containing 200 g/L of paraquat in a suicide attempt. The patient did not seek medical attention until 15 h after ingestion. Initial treatment consisted of the administration of intravenous methylprednisolone, 250 mg once Daily. Seventy-two hours after ingestion the patient was transferred to our tertiary care center. Paraquat concentration was 0.2 mg/L in the serum and urinary concentration was 4.42 mg/L. Antioxidative therapy including the administration of acetylcysteine and an anti-inflammatory therapy employing methylprednisolone (1 g/day) was started. Extended Daily Dialysis was initiated. As the high plasma concentration of paraquat indicated a 100% predicted mortality, we expanded treatment strategies by using the antiproliferative agent rapamycin. A dose of 8 mg/day was started 72 h after the intoxica...
Claudio Ronco - One of the best experts on this subject based on the ideXlab platform.
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Dose and efficiency of renal replacement therapy: continuous renal replacement therapy versus intermittent hemoDialysis versus slow Extended Daily Dialysis.
Critical care medicine, 2020Co-Authors: Zaccaria Ricci, Claudio RoncoAbstract:Acute kidney injury represents an independent risk of death in the intensive care unit and significantly contributes to in-hospital mortality. The only accepted treatment of severe acute kidney injury so far is renal replacement therapy, which is not a causative therapy but rather a life-support treatment. Renal replacement therapy can be performed by several different techniques: intermittent hemoDialysis, slow Extended Daily Dialysis, peritoneal Dialysis, or continuous renal replacement therapy. There is controversy about which technique should be used, which dosage should be selected for each therapy, and whether the technique and/or the dose of renal replacement therapy may impact survival in critically ill patients. After a careful review of the recent literature, definitive conclusions cannot be drawn: Trials are in most cases underpowered and conducted over many years, in which significant changes in the practice of acute dialytic techniques have taken place. Other studies have described therapeutic modalities requiring a high level of specific expertise in the field and generally not easily reproducible in the routine practice. While practitioners are waiting for the ultimate trial to be published, we think it is worth reporting some broad concepts and few suggestions for renal replacement therapy prescription derived from current evidence and from the available experience.
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Operational characteristics of continuous renal replacement modalities used for critically ill patients with acute kidney injury.
International Journal of Artificial Organs, 2020Co-Authors: Zhongping Huang, Jeffrey J. Letteri, William R. Clark, Claudio RoncoAbstract:: Renal replacement therapy (RRT) is required in a significant percentage of patients developing acute kidney injury (AKI) in an intensive care unit (ICU) setting. One of the foremost objectives of continuous renal replacement therapy (CRRT) is the removal of excess fluid and blood solutes that are retained as a consequence of decreased or absent glomerular filtration. Because prescription of CRRT requires goals to be set with regard to the rate and extent of both solute and fluid removal, a thorough understanding of the mechanisms by which solute and fluid removal occurs during CRRT is necessary. The following provides an overview of solute and water transfer during CRRT and this information is placed in the appropriate clinical context with a discussion of recent clinical trials assessing the relationship between CRRT dose and patient survival. Moreover, the differences between solute removal in CRRT and other Dialysis modalities, especially sustained low-efficiency Dialysis (SLED) and Extended Daily Dialysis (EDD), along with the potential clinical implications are discussed.
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Renal Replacement Therapy
Critical Care Clinics, 2015Co-Authors: Gianluca Villa, Zaccaria Ricci, Claudio RoncoAbstract:Endogenous toxins accumulate in blood as a result of many biochemical processes.1 If their concentration exceeds certain levels, they cause illness. Some toxins are volatile (e.g., CO2, ketones) and can be excreted by the lungs through ventilation; others are lipophilic (e.g., bile acids, bilirubin) and can be excreted by the liver via the biliary system; yet others are water soluble and nonvolatile and are excreted by the kidneys.2 When acute kidney injury (AKI) occurs, these water-soluble substances (potassium, phosphate, urea, creatinine) and endogenous toxins (methylguanidine, guanidinosuccinic acid, hippuric acid, uric acid, phenols, beta-2 microglobulin, purines, myo-inositol, etc.), which are normally excreted by the kidney, accumulate in blood. If accumulation progresses, AKI becomes severe; and if their removal is not addressed by either renal recovery or the initiation of artificial renal replacement therapy, the patient dies from uncontrolled hyperkalemia or uremia. Unfortunately, AKI requiring renal replacement therapy (RRT) is relatively common in critically ill patients treated in the intensive care unit (ICU) and involves close to 5% of all admissions.3 When a decision is made that artificial renal replacement therapy is needed, the physician has a variety of techniques at his/her disposal: intermittent hemoDialysis (IHD), continuous renal replacement therapy (CCRT), slow Extended Daily Dialysis (SLEDD), and peritoneal Dialysis, each with its technical variations. All of these techniques rely on the principle that unwanted solutes and water can be removed through a semipermeable membrane-based separating process. The principles of such process have been extensively studied and described.4,5
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dose and efficiency of renal replacement therapy continuous renal replacement therapy versus intermittent hemoDialysis versus slow Extended Daily Dialysis
Critical Care Medicine, 2008Co-Authors: Zaccaria Ricci, Claudio RoncoAbstract:Acute kidney injury represents an independent risk of death in the intensive care unit and significantly contributes to in-hospital mortality. The only accepted treatment of severe acute kidney injury so far is renal replacement therapy, which is not a causative therapy but rather a life-support tre
Danilo Fliser - One of the best experts on this subject based on the ideXlab platform.
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Extended Daily Dialysis
2010Co-Authors: Danilo Fliser, Jan T KielsteinAbstract:Key elements defining a renal replacement therapy as Extended Daily Dialysis (EDD) are Extended Dialysis time (usually 8–18 h) and slow dialysate and blood flow rates. Prospective controlled studies in critically ill patients have documented that small solute clearance with EDD is comparable with that of intermittent hemoDialysis (IHD) and continuous venovenous hemofiltration (CVVH). Patient’s cardiovascular stability during EDD is similar to continuous renal replacement therapy (CRRT). Nightly EDD treatments have the added benefit of unrestricted access of intensive care unit (ICU) staff to the patient during the day, minimizing interference of renal replacement therapy with other ICU activities. EDD combines several advantages of both intermittent and continuous techniques
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pharmacokinetics of ertapenem in critically ill patients with acute renal failure undergoing Extended Daily Dialysis
Nephrology Dialysis Transplantation, 2008Co-Authors: Olaf Burkhardt, Hermann Haller, Danilo Fliser, Volkhard Kaever, Carsten Hafer, Anita Langhoff, Vipul Kumar, Tobias Welte, Jan T KielsteinAbstract:BACKGROUND: Extended (Daily) Dialysis (EDD) is an increasingly popular mode of renal replacement therapy in the ICU (intensive care unit) as it combines the advantages of intermittent haemoDialysis (IHD) and continuous renal replacement therapy (CRRT), i.e. excellent detoxification accompanied by cardiovascular tolerability. The aim of this study was to evaluate pharmacokinetics (PK) of ertapenem, the newest carbapenem with once-Daily dosing, in critically ill patients with anuric acute renal failure (ARF) undergoing EDD. PATIENTS AND METHODS: In a single-centre, prospective, open-label study six ICU patients with ARF undergoing EDD were treated with 1 g ertapenem given as a single intravenous dose. EDD was performed using a high-flux dialyzer (polysulphone, 1.3 m(2)). Blood and dialysate flow were 160 mL/min, and the length of treatment was 480 min. Plasma samples were collected at different time-points up to 24 h after medication. Drug concentrations were determined by a validated LC-MS method. Free drug concentrations were estimated using a two-class binding site equation. RESULTS: After a single dose of 1000 mg free ertapenem, protein-unbound plasma concentrations exceeded a MIC(90) value of 2 mg/L for >20 h after dosing. The clearance of the tested dialyzer was 38.5 +/- 14.2 mL/min. CONCLUSIONS: In contrast to patients undergoing regular IHD, in which a dose reduction is required, our data suggest that in patients treated with EDD a standard dose of ertapenem (1 g/day), i.e. dose for patients without renal failure, is required to maintain adequate plasma drug levels.
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pharmacokinetics of moxifloxacin and levofloxacin in intensive care unit patients who have acute renal failure and undergo Extended Daily Dialysis
Clinical Journal of The American Society of Nephrology, 2006Co-Authors: David Czock, Hermann Haller, Carsten Hafer, Anita Langhoff, Cordula Husiglinde, Timo Schopke, Kirsten De Groot, Stefanie Swoboda, Ernst Kuse, Danilo FliserAbstract:Extended Daily Dialysis (EDD) is increasingly popular in the treatment of acute renal failure (ARF). EDD could remove drugs to a much different degree compared with intermittent standard hemoDialysis or continuous renal replacement therapies; however, there are only scarce data on how EDD influences the pharmacokinetics of frequently used drugs. The aim of this study was to determine the pharmacokinetics of two quinolone antibiotics in patients who had anuric ARF and were being treated with EDD. Adult patients who were in the intensive care unit at a tertiary care university hospital and receiving moxifloxacin (n 10) or levofloxacin (n 5) therapy were included. The antibiotics were administered intravenously 8 h (400 mg of moxifloxacin) or 12 h (500 mg of levofloxacin) before EDD to study pharmacokinetics off and on EDD. Treatment lasted 8 h; blood and dialysate flow rates were 160 ml/min. In addition to standard pharmacokinetic parameters, the total dialysate concentration of both drugs was measured using a technically simple single-pass batch Dialysis system for EDD. Moxifloxacin pharmacokinetics in critically ill patients who had ARF and were undergoing EDD were similar to those in healthy subjects without renal impairment. Levofloxacin, although removed by EDD, had a lower total clearance compared with healthy subjects. According to these findings, anuric critically ill patients who are undergoing EDD should be treated with the standard dosage of moxifloxacin (400 mg/d intravenously). The levofloxacin dosage, however, should be reduced according to the intensity of renal replacement therapy.
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pharmacokinetics and total elimination of meropenem and vancomycin in intensive care unit patients undergoing Extended Daily Dialysis
Critical Care Medicine, 2006Co-Authors: Jan T Kielstein, Carsten Hafer, David Czock, Timo Schopke, Ernst Kuse, Stefanie M Bodeboger, Frieder Keller, Danilo FliserAbstract:Objective:Extended Daily Dialysis (EDD) combines the advantage of both intermittent hemoDialysis and continuous renal replacement therapy: excellent detoxification accompanied by cardiovascular tolerability. The aim of this study was to evaluate pharmacokinetics of meropenem and vancomycin in critic
Nigel Fealy - One of the best experts on this subject based on the ideXlab platform.
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A pilot randomized controlled comparison of Extended Daily Dialysis with filtration and continuous veno-venous hemofiltration: fluid removal and hemodynamics.
International Journal of Artificial Organs, 2020Co-Authors: Ian T. Baldwin, Rinaldo Bellomo, Toshio Naka, Bill Koch, Nigel FealyAbstract:OBJECTIVES: Extended intermittent dialytic techniques are increasingly being reported in the treatment of ARF in the ICU but few randomized controlled trials exist. We compared one such technique to a technique of continuous renal replacement therapy with regard to fluid removal and hemodynamics. METHODS: Sixteen critically ill patients with ARF were enrolled in a randomized controlled trial at the ICU of a tertiary hospital. We randomized eight patients to three consecutive days of treatment with either Extended Daily Dialysis with filtration (EDDf) or Continuous Veno-Venous Hemofiltration (CVVH) and compared fluid removal and hemodynamics during treatment. RESULTS: A total of 16.6 liters of fluid were removed during EDDf (830 mL/day over 20 treatment days) compared with 15.4 liters (700 ml/day over 22 treatment days) during CVVH. Median fluid removal per day was 1837 mL in the EDDf group compared with 1410 mL per day in the CVVH group, p=0.674. Median hourly fluid removal rate was 252 mL for EDDf and 128 mL for CVVH (p
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a pilot randomized controlled comparison of Extended Daily Dialysis with filtration and continuous veno venous hemofiltration fluid removal and hemodynamics
International Journal of Artificial Organs, 2007Co-Authors: Ian T. Baldwin, Rinaldo Bellomo, Toshio Naka, Bill Koch, Nigel FealyAbstract:OBJECTIVES: Extended intermittent dialytic techniques are increasingly being reported in the treatment of ARF in the ICU but few randomized controlled trials exist. We compared one such technique to a technique of continuous renal replacement therapy with regard to fluid removal and hemodynamics. METHODS: Sixteen critically ill patients with ARF were enrolled in a randomized controlled trial at the ICU of a tertiary hospital. We randomized eight patients to three consecutive days of treatment with either Extended Daily Dialysis with filtration (EDDf) or Continuous Veno-Venous Hemofiltration (CVVH) and compared fluid removal and hemodynamics during treatment. RESULTS: A total of 16.6 liters of fluid were removed during EDDf (830 mL/day over 20 treatment days) compared with 15.4 liters (700 ml/day over 22 treatment days) during CVVH. Median fluid removal per day was 1837 mL in the EDDf group compared with 1410 mL per day in the CVVH group, p=0.674. Median hourly fluid removal rate was 252 mL for EDDf and 128 mL for CVVH (p<0.01). Mean arterial pressure in the EDDf group was lower at two hours after starting treatment (76 mmHg vs. 94 mmHg) in the CVVH group; p= 0.031. There was no significant difference between groups for heart rate, CVP and noradrenaline dose at all time intervals measured. CONCLUSIONS: Adequate prescribed fluid removal was achieved with both techniques. However, as expected, fluid was removed at a faster rate during EDDf. This was initially associated with a lower blood pressure than during CVVH where blood pressure increased.
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A pilot randomised controlled comparison of continuous veno–venous haemofiltration and Extended Daily Dialysis with filtration: effect on small solutes and acid–base balance
Intensive Care Medicine, 2007Co-Authors: Ian Baldwin, Bill Koch, Toshio Naka, Nigel Fealy, Rinaldo BellomoAbstract:Background and aims Continuous veno–venous haemofiltration (CVVH) is an established treatment for acute renal failure (ARF). Recently, Extended intermittent dialytic techniques have been proposed for the treatment of ARF. The aim of this study was to compare these two approaches. Setting Intensive care unit of tertiary hospital. Subjects Sixteen critically ill patients with ARF. Design Randomised controlled trial. Intervention We randomised sixteen patients to three consecutive days of treatment with either CVVH (8) or Extended Daily Dialysis with filtration (EDDf) (8) and compared small-solute, electrolyte and acid–base control. Results There was no significant difference between the two therapies for urea or creatinine levels over 3 days. Of 80 electrolyte measurements taken before treatment, 19 were abnormal. All values were corrected as a result of treatment, except for one patient in the CVVH group who developed hypophosphataemia (0.54 mmol/l) at 72 h. After 3 days of treatment, there was a mild but persistent metabolic acidosis in the EDDf group compared to the CVVH group (median bicarbonate: 20 mmol/l vs. 29 mmol/l: p = 0.039; median base deficit: –4 mEq/l vs. –2.1 mEq/l, p = 0.033). Conclusions CVVH and EDDf as prescribed achieved similar control of urea, creatinine and electrolytes. Acidosis was better controlled with CVVH.
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a pilot randomised controlled comparison of continuous veno venous haemofiltration and Extended Daily Dialysis with filtration effect on small solutes and acid base balance
Intensive Care Medicine, 2007Co-Authors: Ian Baldwin, Bill Koch, Toshio Naka, Nigel Fealy, Rinaldo BellomoAbstract:Continuous veno–venous haemofiltration (CVVH) is an established treatment for acute renal failure (ARF). Recently, Extended intermittent dialytic techniques have been proposed for the treatment of ARF. The aim of this study was to compare these two approaches. Intensive care unit of tertiary hospital. Sixteen critically ill patients with ARF. Randomised controlled trial. We randomised sixteen patients to three consecutive days of treatment with either CVVH (8) or Extended Daily Dialysis with filtration (EDDf) (8) and compared small-solute, electrolyte and acid–base control. There was no significant difference between the two therapies for urea or creatinine levels over 3 days. Of 80 electrolyte measurements taken before treatment, 19 were abnormal. All values were corrected as a result of treatment, except for one patient in the CVVH group who developed hypophosphataemia (0.54 mmol/l) at 72 h. After 3 days of treatment, there was a mild but persistent metabolic acidosis in the EDDf group compared to the CVVH group (median bicarbonate: 20 mmol/l vs. 29 mmol/l: p = 0.039; median base deficit: –4 mEq/l vs. –2.1 mEq/l, p = 0.033). CVVH and EDDf as prescribed achieved similar control of urea, creatinine and electrolytes. Acidosis was better controlled with CVVH.
