title: Evaluation of Intermittent Hemodialysis in Critically Ill Cancer Patients with Acute Kidney Injury Using Single-Pass Batch Equipment.
abstract: BACKGROUND
  Data on renal replacement therapy (RRT) in cancer patients with acute kidney injury (AKI) in the intensive care unit (ICU) is scarce. The aim of this study was to assess the safety and the adequacy of intermittent hemodialysis (IHD) in critically ill cancer patients with AKI.
  
  
  RESULTS
  In this observational prospective cohort study, 149 ICU cancer patients with AKI were treated with 448 single-pass batch IHD procedures and evaluated from June 2010 to June 2012. Primary outcomes were IHD complications (hypotension and clotting) and adequacy. A multiple logistic regression was performed in order to identify factors associated with IHD complications (hypotension and clotting). Patients were 62.2 ± 14.3 years old, 86.6% had a solid cancer, sepsis was the main AKI cause (51%) and in-hospital mortality was 59.7%. RRT session time was 240 (180-300) min, blood/dialysate flow was 250 (200-300) mL/min and UF was 1000 (0-2000) ml. Hypotension occurred in 25% of the sessions. Independent risk factors (RF) for hypotension were dialysate conductivity (each ms/cm, OR 0.81, CI 0.69-0.95), initial mean arterial pressure (each 10 mmHg, OR 0.49, CI 0.40-0.61) and SOFA score (OR 1.16, CI 1.03-1.30). Clotting and malfunctioning catheters (MC) occurred in 23.8% and 29.2% of the procedures, respectively. Independent RF for clotting were heparin use (OR 0.57, CI 0.33-0.99), MC (OR 3.59, CI 2.24-5.77) and RRT system pressure increase over 25% (OR 2.15, CI 1.61-4.17). Post RRT blood tests were urea 71 (49-104) mg/dL, creatinine 2.71 (2.10-3.8) mg/dL, bicarbonate 24.1 (22.5-25.5) mEq/L and K 3.8 (3.5-4.1) mEq/L.
  
  
  CONCLUSIONS
  IHD for critically ill patients with cancer and AKI offered acceptable hemodynamic stability and provided adequate metabolic control.
authors.affiliation: Nephrology Division, Sao Paulo State Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil.
authors.forename: Verônica
authors.initials: V
authors.lastname: Torres da Costa E Silva
authors.affiliation: Nephrology Division, Sao Paulo State Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil.
authors.forename: Elerson C
authors.initials: EC
authors.lastname: Costalonga
authors.affiliation: Nephrology Division, Sao Paulo State Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil.
authors.forename: Ana Paula Leandro
authors.initials: AP
authors.lastname: Oliveira
authors.affiliation: Nephrology Division, Sao Paulo State Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil.
authors.forename: James
authors.initials: J
authors.lastname: Hung
authors.affiliation: Nephrology Division, Sao Paulo State Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil.
authors.forename: Renato Antunes
authors.initials: RA
authors.lastname: Caires
authors.affiliation: Intensive Care Unit Department, Sao Paulo State Cancer Institute, University of Sao Paulo School Medical School, Sao Paulo, Sao Paulo, Brazil.
authors.forename: Ludhmila Abrahão
authors.initials: LA
authors.lastname: Hajjar
authors.affiliation: Intensive Care Unit Department, Sao Paulo State Cancer Institute, University of Sao Paulo School Medical School, Sao Paulo, Sao Paulo, Brazil.
authors.forename: Julia T
authors.initials: JT
authors.lastname: Fukushima
authors.affiliation: Nephrology Division, Sao Paulo State Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil.
authors.forename: Cilene Muniz
authors.initials: CM
authors.lastname: Soares
authors.affiliation: Nephrology Division, Sao Paulo State Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil.
authors.forename: Juliana Silva
authors.initials: JS
authors.lastname: Bezerra
authors.affiliation: Nephrology Division, Sao Paulo State Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil.
authors.forename: Luciane
authors.initials: L
authors.lastname: Oikawa
authors.affiliation: LIM 12, Division of Nephrology, University of Sao Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Luis
authors.initials: L
authors.lastname: Yu
authors.affiliation: LIM 12, Division of Nephrology, University of Sao Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Emmanuel A
authors.initials: EA
authors.lastname: Burdmann
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016638:Critical Illness; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D011446:Prospective Studies; D006435:Renal Dialysis; D017582:Renal Replacement Therapy; D012307:Risk Factors