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Related Concept Videos

Renal Failure: Dose Adjustments01:11

Renal Failure: Dose Adjustments

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In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
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...
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Factors Affecting Renal Clearance: Renal Impairment01:17

Factors Affecting Renal Clearance: Renal Impairment

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Renal dysfunction significantly impairs the renal clearance of drugs, leading to potential complications in drug therapy. Renal failure, which can be caused by various factors, poses a significant challenge in the elimination of drugs from the body.
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
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Dialysis01:27

Dialysis

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Renal failure occurs when the kidneys lose their ability to filter waste products from the blood effectively. It can be classified into two types: acute renal failure (ARF) and chronic renal failure (CRF).
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...
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Renal Drug Excretion: Tubular Reabsorption01:25

Renal Drug Excretion: Tubular Reabsorption

171
Tubular reabsorption, a process occurring post-glomerular filtration of drugs in the renal tubule, is a critical determinant of drug half-life. During the process of renal excretion, as the glomerular filtrate progresses to the distal convoluted tubule (DCT), drugs that are highly permeable, lipophilic, and nonionized undergo passive reabsorption from the tubular fluid into the surrounding peritubular capillaries. This reabsorption process restricts their elimination through the kidneys. This...
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Renal Drug Excretion: Tubular Secretion01:28

Renal Drug Excretion: Tubular Secretion

182
Active tubular secretion is a robust, energy-demanding process that utilizes carrier systems to transport drugs into renal tubules. The active renal secretion systems include the organic anion transporter (OAT) for weak acids and the organic cation transporter (OCT) for weak bases. Structurally similar drugs can compete for the same transporter, potentially leading to drug accumulation and toxicity. However, this principle can be exploited therapeutically. One example is probenecid (Probalan),...
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Renal Drug Clearance: Overview01:06

Renal Drug Clearance: Overview

191
Renal clearance is a crucial parameter in pharmacokinetics that quantifies the rate at which the kidneys excrete a drug. It represents a constant fraction of the central volume of distribution containing the drug that the kidney eliminates per unit of time.
Renal clearance can be calculated using different methods. One approach is to divide the urinary drug excretion rate by the plasma drug concentration. This method directly measures renal clearance, indicating the kidneys' efficiency in...
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Initial renal replacement therapy (RRT) modality associates with 90-day postdischarge RRT dependence in critically

Jay L Koyner1, Rachel H Mackey2, Jorge Echeverri3

  • 1Section of Nephrology, University of Chicago, Chicago, IL, USA.

Journal of Critical Care
|March 9, 2024
PubMed
Summary

Continuous renal replacement therapy (CRRT) was associated with a 30% lower odds of renal replacement therapy (RRT) dependence at 90 days postdischarge compared to intermittent hemodialysis (IHD) in acute kidney injury (AKI) patients. This suggests CRRT may improve long-term kidney function recovery.

Keywords:
Acute kidney injuryContinuous renal replacement therapy (CRRT)Intermittent hemodialysis (IHD)RRT dependenceRRT modality

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Area of Science:

  • Nephrology
  • Critical Care Medicine
  • Health Services Research

Background:

  • Acute kidney injury (AKI) is common in critically ill patients, often necessitating renal replacement therapy (RRT).
  • Continuous renal replacement therapy (CRRT) and intermittent hemodialysis (IHD) are primary RRT modalities in intensive care units (ICUs).
  • The long-term impact of RRT modality on kidney function recovery, specifically RRT dependence, remains an important clinical question.

Purpose of the Study:

  • To compare the real-world effectiveness of CRRT versus IHD on RRT dependence at 90 days postdischarge.
  • To analyze RRT dependence among intensive care unit (ICU) patients surviving acute kidney injury (AKI) after RRT.

Main Methods:

  • A retrospective analysis of US hospital discharge data (Premier PINC AI Healthcare Database [PHD]) from January 2018 to June 2021.
  • Comparison of continuous renal replacement therapy (CRRT) versus intermittent hemodialysis (IHD) in adult ICU patients with AKI.
  • Inverse probability treatment weighting (IPTW) was used to balance baseline characteristics between CRRT and IHD groups.
  • RRT dependence was defined as ≥2 RRT treatments in the last 8 days before 90-day postdischarge assessment.

Main Results:

  • Of 34,804 patients, 3804 had 90-day follow-up claims data; 1064 received CRRT and 2740 received IHD.
  • CRRT patients were younger and had more severe illness (sepsis, shock, mechanical ventilation) but fewer comorbidities than IHD patients.
  • CRRT was associated with lower RRT dependence at hospital discharge (26.5% vs. 29.8%) and at 90 days postdischarge (4.9% vs. 7.4%).
  • Adjusted analysis showed a significantly lower odds of RRT dependence at 90 days for CRRT vs. IHD (OR: 0.68; 95% CI: 0.47-0.97; P=0.03).

Conclusions:

  • Continuous renal replacement therapy (CRRT) was associated with a 30% lower adjusted odds of renal replacement therapy (RRT) dependence at 90 days postdischarge compared to intermittent hemodialysis (IHD).
  • These findings suggest that CRRT may be associated with better long-term kidney function recovery in survivors of acute kidney injury (AKI).
  • Results were consistent across multiple sensitivity analyses, reinforcing the robustness of the findings.