Related Experiment Videos
Current worldwide practice of dialysis dose prescription in acute renal failure
Claudio Ronco1, Zaccaria Ricci, Rinaldo Bellomo
1Department of Nephrology, Dialysis and Transplantation, S. Bortolo Hospital, Vicenza, Italy. cronco@goldnet.it
Purpose Of Review:
The practice of renal replacement therapy for acute renal failure varies greatly around the world. This is especially true for the dose of renal replacement therapy. This review describes the epidemiology of dialysis prescription and delivery around the world based on recent observational studies and international surveys. Furthermore, a brief speculation on the concept of adequacy of therapy is provided.
Recent Findings:
Following the publication of the first large prospective randomized trial on the effects of treatment dose on outcome of patients with acute renal failure a certain consensus has been achieved on the adequacy of 35 ml/kg/h of clearance in continuous therapies. Surveys conducted in 1998 had demonstrated that such adequate therapy was only prescribed in a minority of patients. Recent observations based on questionnaires and surveys confirm that the number of centers prescribing adequate dialysis dose is increasing, but there is still a large number of institutions where prescription is made with no specific adequacy targets and effective delivery is not measured. Several barriers have been identified to reach adequacy targets including logistics, costs, personnel and others.
Summary:
The analysis of the epidemiology of dialysis dose around the world shows a complex picture. Wide variations in practice are present although a significant effort has been made to standardize the prescription and delivery of therapy.
Related Concept Videos
Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant
Renal Failure: Dose Adjustments
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
Acute Kidney Injury V: Interprofessional Care
Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration
Dialysis
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
Dialysis