title: Disease severity adversely affects delivery of dialysis in acute renal failure.
abstract: OBJECTIVE
  Methods of intermittent hemodialysis (IHD) dose quantification in acute renal failure (ARF) are not well defined. This observational study was designed to evaluate the impact of disease activity on delivered single pool Kt/V(urea) in ARF patients.
  
  
  METHODS
  100 patients with severe ARF (acute intrinsic renal disease in 18 patients, nephrotoxic acute tubular necrosis in 38 patients, and septic ARF in 44 patients) were analyzed during four consecutive sessions of IHD, performed for 3.5-5 h every other day or daily. Target IHD dose was a single pool Kt/V(urea) of 1.2 or more per dialysis session for all patients. Prescribed Kt/V(urea) was calculated from desired dialyzer clearance (K), desired treatment time (t) and anthropometric estimates for urea distribution volume (V). The desired clearance (K) was estimated from prescribed blood flow rate and manufacturer's charts of in vivo data obtained in maintenance dialysis patients. Delivered single pool Kt/V(urea) was calculated using the Daugirdas equation.
  
  
  RESULTS
  None of the patients had prescription failure of the target dose. The delivered IHD doses were substantially lower than the prescribed Kt/V values, particularly in ARF patients with sepsis/septic shock. Stratification according to disease severity revealed that all patients with isolated ARF, but none with 3 or more organ failures and none who needed vasopressive support received the target dose.
  
  
  CONCLUSIONS
  Prescription of target IHD dose by single pool Kt/V(urea) resulted in suboptimal dialysis dose delivery in critically ill patients. Numerous patient-related and treatment-immanent factors acting in concert reduced the delivered dose.
authors.affiliation: Department of Internal Medicine, University of Munich, Munich, Germany. hschiffl@hotmail.com
authors.forename: Helmut
authors.initials: H
authors.lastname: Schiffl
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D000328:Adult; D001774:Blood Chemical Analysis; D001806:Blood Urea Nitrogen; D015331:Cohort Studies; D015314:Dialysis Solutions / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D015314:Dialysis Solutions