Navegando por Palavras-chave "continuous renal replacement therapy"

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    Timing of renal replacement therapy initiation in acute renal failure: A meta-analysis
    (Elsevier B.V., 2008-08-01) Seabra, Victor F.; Balk, Ethan M.; Liangos, Orfeas; Sosa, Marie Anne; Cendoroglo, Miguel [UNIFESP]; Jaber, Bertrand L.; Caritas St Elizabeths Med Ctr; Universidade de São Paulo (USP); Tufts Med Ctr; Universidade Federal de São Paulo (UNIFESP)
    Background: Some studies have suggested that early institution of renal replacement therapy (RRT) might be associated with improved outcomes in patients with acute renal failure (ARF).Study Design: A systematic review and meta-analysis of randomized controlled trials and cohort comparative studies to assess the effect of early RRT on mortality in patients with ARF.Setting & Population: Hospitalized adult patients with ARF.Selection Criteria for Studies: We searched several databases for studies that compared the effect of early and late RRT initiation on mortality in patients with ARF We included studies of various designs.Intervention: Early RRT as defined in the individual studies.Outcomes: the primary outcome measure was the effect of early RRT on mortality stratified by study design. the pooled risk ratio (RR) for mortality was compiled using a random-effects model. Heterogeneity was evaluated by means of subgroup analysis and meta-regression.Results: We identified 23 studies (5 randomized or quasi-randomized controlled trials, 1 prospective and 16 retrospective comparative cohort studies, and 1 single-arm study with a historic control group). By using meta-analysis of randomized trials, early RRT was associated with a nonsignificant 36% mortality risk reduction (RR, 0.64; 95% confidence interval, 0.40 to 1.05; P = 0.08). Conversely, in cohort studies, early RRT was associated with a statistically significant 28% mortality risk reduction (RR, 0.72; 95% confidence interval, 0.64 to 0.82; P < 0.001). the overall test for heterogeneity among cohort studies was significant (P = 0.005). Meta-regression yielded no significant associations; however, early dialysis therapy was associated more strongly with lower mortality in smaller studies (n < 100) by means of subgroup analysis.Limitations: Paucity of randomized controlled trials, use of variable definitions of early RRT, and publication bias preclude definitive conclusions.Conclusion: This hypothesis-generating meta-analysis suggests that early initiation of RRT in patients with ARF might be associated with improved survival, calling for an adequately powered randomized controlled trial to address this question.
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    The use of regional citrate anticoagulation for continuous venovenous hemodiafiltration in acute kidney injury
    (Lippincott Williams & Wilkins, 2008-11-01) Durao, Marcelino S. [UNIFESP]; Monte, Julio C. M. [UNIFESP]; Batista, Marcelo C. [UNIFESP]; Oliveira, Moacir; Lizuka, Llson J.; Santos, Bento F. [UNIFESP]; Pereira, Virgilio G.; Cendoroglo, Miguel [UNIFESP]; Santos, Oscar F. P. [UNIFESP]; Hosp Israelita Albert Einstein; Universidade Federal de São Paulo (UNIFESP)
    Objective. Continuous renal replacement therapy is commonly used in the treatment of acute kidney injury. Although the optimal anticoagulation system is not well defined, citrate has emerged as the most promising method. We evaluated the data of 143 patients with acute kidney injury subjected to citrate-based continuous venovenous hemodiafiltration.Design: Retrospective cohort study.Setting. Intensive care unit of tertiary care private hospital.Patients. Patients with acute kidney injury treated from February 2004 to July 2006.Interventions: None.Measurements and Main Results: the main cause of acute kidney injury was sepsis (58%). the mean dialysis dose was 36.6 mL/kg/hr allowing for excellent metabolic control (last tests: creatinine, 1.1 mg/dL; urea, 46 mg/dL). No significant bleeding, severe electrolyte, or calcium disorders were observed. of the 418 filters used, almost 28,000 hrs of treatment, hemofilter patency was 68% at 72 hrs. Hospital mortality was 59%, and 22% of survivors were dialysis-dependent at the time of discharge. Within our sample, we identified 21 patients with liver failure (mean prothrombin time index, 21% vs. 67%, p < 0.001). This group presented with a lesser median systemic ionized calcium level (1.06 vs. 1.12 mmol/L, p < 0.001) and similar mean total calcium level (8.5 vs. 8.6 mg/dL, not significant), compared with patients without liver failure. These subjects also showed acidemia (median pH, 7.31 vs. 7.40, p < 0.001); however, they exhibited higher levels of lactate (median 29 vs. 16 mg/dL, p < 0.001), chloride (mean 109 vs. 107 mEq/L, p = 0.045) and had a trend to higher mortality rate (76% vs. 56%).Conclusions. Besides a trend toward higher mortality rate observed in the group with liver failure, we found that citrate-based continuous venovenous hemodialfiltration allowed an effective dialysis dose and reasonable filter patency. (Crit Care Med 2008; 36:3024-3029)