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Continuous Renal Replacement Therapy Dosing in the Severely Underweight: A Case Report
Benjamin R Griffin1, Sophia Ambruso1,2, Anna Jovanovich1,2
1Division of Renal Diseases and Hypertension, University of Colorado Denver Anschutz Medical Campus, Aurora, CO.
Kidney Medicine
|August 1, 2020
Summary
For continuous renal replacement therapy, ideal body weight (IBW) is a better estimate than actual body weight for dosing in underweight patients. Using actual body weight may lead to inadequate treatment of metabolic acidosis.
Area of Science:
- Nephrology
- Critical Care Medicine
- Clinical Pharmacology
Background:
- Continuous renal replacement therapy (CRRT) effluent dose recommendations (20-25 mL/kg/h) are debated regarding actual vs. ideal body weight (IBW) in extreme body mass index.
- Metabolic acidosis is a critical complication in patients with severe anorexia.
Observation:
- A severely underweight patient with anorexia developed metabolic acidosis and anuria, requiring CRRT.
- Treatment involved continuous venovenous hemodialysis converted to hemodiafiltration with hypertonic bicarbonate for refractory acidosis.
Findings:
- Calculations of the effective volume of distribution in this patient suggest IBW is a more accurate predictor than actual body weight.
- Inadequate CRRT effluent flow, if based on actual body weight in severely underweight individuals, may result in insufficient correction of metabolic derangements.
Implications:
- Dosing calculations for CRRT in extremely underweight patients should prioritize ideal body weight (IBW) over actual body weight.
- Accurate CRRT dosing based on IBW is crucial for effective management of metabolic acidosis and other derangements in this vulnerable population.
Keywords:
Acute kidney injury (AKI)continuous renal replacement therapy (CRRT)dialysis dosevolume of distributionMore Related Videos
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