title: Extended daily dialysis in acute kidney injury patients: metabolic and fluid control and risk factors for death.
abstract: Intermittent hemodialysis (IHD) and continuous renal replacement therapies (CRRT) are used as Acute Kidney Injury (AKI) therapy and have certain advantages and disadvantages. Extended daily dialysis (EDD) has emerged as an alternative to CRRT in the management of hemodynamically unstable AKI patients, mainly in developed countries.
  
  
  OBJECTIVE
  We hypothesized that EDD is a safe option for AKI treatment and aimed to describe metabolic and fluid control of AKI patients undergoing EDD and identify complications and risk factors associated with death.
  
  
  METHODS
  This is an observational and retrospective study describing introduction of EDD at our institution. A total of 231 hemodynamically unstable AKI patients (noradrenalin dose between 0.3 and 1.0 ucg/kg/min) were assigned to 1367 EDD session. EDD consisted of 6-8 h of HD 6 days a week, with blood flow of 200 ml/min, dialysate flows of 300 ml/min.
  
  
  RESULTS
  Mean age was 60.6±15.8 years, 97.4% of patients were in the intensive care unit, and sepsis was the main etiology of AKI (76.2). BUN and creatinine levels stabilized after four sessions at around 38 and 2.4 mg/dl, respectively. Fluid balance decreased progressively and stabilized around zero after five sessions. Weekly delivered Kt/V was 5.94±0.7. Hypotension and filter clotting occurred in 47.5 and 12.4% of treatment session, respectively. Regarding AKI outcome, 22.5% of patients presented renal function recovery, 5.6% of patients remained on dialysis after 30 days, and 71.9% of patients died. Age and focus abdominal sepsis were identified as risk factors for death. Urine output and negative fluid balance were identified as protective factors.
  
  
  CONCLUSIONS
  EDD is effective for AKI patients, allowing adequate metabolic and fluid control. Age, focus abdominal sepsis, and lower urine output as well as positive fluid balance after two EDD sessions were associated significantly with death.
authors.affiliation: University São Paulo State-UNESP, Distrito de Rubiao Junior, Botucatu, São Paulo, Brazil.
authors.forename: Daniela
authors.initials: D
authors.lastname: Ponce
authors.affiliation: University São Paulo State-UNESP, Distrito de Rubiao Junior, Botucatu, São Paulo, Brazil.
authors.forename: Juliana Maria Gera
authors.initials: JM
authors.lastname: Abrão
authors.affiliation: University São Paulo State-UNESP, Distrito de Rubiao Junior, Botucatu, São Paulo, Brazil.
authors.forename: Bianca Ballarin
authors.initials: BB
authors.lastname: Albino
authors.affiliation: University São Paulo State-UNESP, Distrito de Rubiao Junior, Botucatu, São Paulo, Brazil.
authors.forename: André Luis
authors.initials: AL
authors.lastname: Balbi
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000150:complications / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000367:Age Factors; D000368:Aged; D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000097:blood / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D016482:Urinalysis
chemical_list: D003404:Creatinine