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Extended Daily Dialysis in Acute Kidney Injury Patients: Metabolic and Fluid Control and Risk Factors for Death

dc.contributor.authorPonce, Daniela [UNESP]
dc.contributor.authorGera Abrao, Juliana Maria [UNESP]
dc.contributor.authorAlbino, Bianca Ballarin [UNESP]
dc.contributor.authorBalbi, André Luis [UNESP]
dc.contributor.institutionUniversidade Estadual Paulista (Unesp)
dc.date.accessioned2014-12-03T13:08:45Z
dc.date.available2014-12-03T13:08:45Z
dc.date.issued2013-12-11
dc.description.abstractIntermittent hemodialysis (IHD) and continuous renal replacement therapies (CRRT) are used as Acute Kidney Injury (AKI) therapy and have certain advantages and disadvantages. Extended daily dialysis (EDD) has emerged as an alternative to CRRT in the management of hemodynamically unstable AKI patients, mainly in developed countries.Objectives: We hypothesized that EDD is a safe option for AKI treatment and aimed to describe metabolic and fluid control of AKI patients undergoing EDD and identify complications and risk factors associated with death.Study Selection: This is an observational and retrospective study describing introduction of EDD at our institution. A total of 231 hemodynamically unstable AKI patients (noradrenalin dose between 0.3 and 1.0 ucg/kg/min) were assigned to 1367 EDD session. EDD consisted of 6-8 h of HD 6 days a week, with blood flow of 200 ml/min, dialysate flows of 300 ml/min.Data Synthesis: Mean age was 60.6 +/- 15.8 years, 97.4% of patients were in the intensive care unit, and sepsis was the main etiology of AKI (76.2). BUN and creatinine levels stabilized after four sessions at around 38 and 2.4 mg/dl, respectively. Fluid balance decreased progressively and stabilized around zero after five sessions. Weekly delivered Kt/V was 5.94 +/- 0.7. Hypotension and filter clotting occurred in 47.5 and 12.4% of treatment session, respectively. Regarding AKI outcome, 22.5% of patients presented renal function recovery, 5.6% of patients remained on dialysis after 30 days, and 71.9% of patients died. Age and focus abdominal sepsis were identified as risk factors for death. Urine output and negative fluid balance were identified as protective factors.Conclusions: EDD is effective for AKI patients, allowing adequate metabolic and fluid control. Age, focus abdominal sepsis, and lower urine output as well as positive fluid balance after two EDD sessions were associated significantly with death.en
dc.description.affiliationUniv Sao Paulo State UNESP, Sao Paulo, Brazil
dc.description.affiliationUnespUniv Sao Paulo State UNESP, Sao Paulo, Brazil
dc.format.extent8
dc.identifierhttp://dx.doi.org/10.1371/journal.pone.0081697
dc.identifier.citationPlos One. San Francisco: Public Library Science, v. 8, n. 12, 8 p., 2013.
dc.identifier.doi10.1371/journal.pone.0081697
dc.identifier.fileWOS000328730300046.pdf
dc.identifier.issn1932-6203
dc.identifier.lattes5697804493071661
dc.identifier.urihttp://hdl.handle.net/11449/111551
dc.identifier.wosWOS:000328730300046
dc.language.isoeng
dc.publisherPublic Library Science
dc.relation.ispartofPLOS ONE
dc.relation.ispartofjcr2.766
dc.relation.ispartofsjr1,164
dc.rights.accessRightsAcesso aberto
dc.sourceWeb of Science
dc.titleExtended Daily Dialysis in Acute Kidney Injury Patients: Metabolic and Fluid Control and Risk Factors for Deathen
dc.typeArtigo
dcterms.rightsHolderPublic Library Science
dspace.entity.typePublication
unesp.author.lattes5697804493071661[4]
unesp.author.orcid0000-0001-8366-5064[4]
unesp.author.orcid0000-0002-6178-6938[1]
unesp.campusUniversidade Estadual Paulista (UNESP), Faculdade de Medicina, Botucatupt
unesp.departmentClínica Médica - FMBpt

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