For Publishers
DiscoveryMetadataPeer reviewHostingPublishing
For Researchers
JoinPublishReviewCollect
Register
Blog
About
Search
Advanced search
My ScienceOpen
Search
For Publishers
For Researchers
Blog
About
41
views
15
references
 Top references
cited by
7
    
0 reviews
 Review
0
comments
 Comment
0
recommends
+1 Recommend
0 collections
    0
    shares
      120
      similar
       All similar
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      In vivo validation of the adequacy calculator for continuous renal replacement therapies

      research-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Introduction

          The study was conducted to validate in vivo the Adequacy Calculator, a Microsoft Excel-based program, designed to assess the prescription and delivery of renal replacement therapy in the critical care setting.

          Methods

          The design was a prospective cohort study, set in two intensive care units of teaching hospitals. The participants were 30 consecutive critically ill patients with acute renal failure treated with 106 continuous renal replacement therapies (CRRT). Urea clearance computation was performed with the Adequacy Calculator ( K CALC). Simultaneous blood and effluent urea samples were collected to measure the effectively delivered urea clearance ( K DEL) at the beginning of each treatment and, during 73 treatments, between the 18th and 24th treatment hour. The correlation between 179 computed and 179 measured clearances was assessed. Fractional clearances for urea were calculated as sp Kt/ V (where sp represents single pool, K is clearance, t is time, and V is urea volume of distribution) obtained from software prescription and compared with the delivered sp Kt/ V obtained from empirical data.

          Results

          We found that the value of clearance predicted by the calculator was strongly correlated with the value obtained from computation on blood and dialysate determination ( r = 0.97) during the first 24 treatment hours, regardless of the renal replacement modality used. The delivered sp Kt/ V (1.25) was less than prescribed (1.4) from the Adequacy Calculator by 10.7%, owing to therapy downtime.

          Conclusion

          The Adequacy Calculator is a simple tool for prescribing CRRT and for predicting the delivered dose. The calculator might be a helpful tool for standardizing therapy and for comparing disparate treatments, making it possible to perform large multi-centre studies on CRRT.

          Related collections

          Most cited references15

          • Record: found
          • Abstract: found
          • Article: not found

          Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial.

          C. Ronco, R Bellomo, P Homel … (2000)
          Continuous veno-venous haemofiltration is increasingly used to treat acute renal failure in critically ill patients, but a clear definition of an adequate treatment dose has not been established. We undertook a prospective randomised study of the impact different ultrafiltration doses in continuous renal replacement therapy on survival. We enrolled 425 patients, with a mean age of 61 years, in intensive care who had acute renal failure. Patients were randomly assigned ultrafiltration at 20 mL h(-1) kg(-1) (group 1, n=146), 35 mL h(-1) kg(-1) (group 2, n=139), or 45 mL h(-1) kg(-1) (group 3, n=140). The primary endpoint was survival at 15 days after stopping haemofiltration. We also assessed recovery of renal function and frequency of complications during treatment. Analysis was by intention to treat. Survival in group 1 was significantly lower than in groups 2 (p=0.0007) and 3 (p=0.0013). Survival in groups 2 and 3 did not differ significantly (p=0.87). Adjustment for possible confounding factors did not change the pattern of differences among the groups. Survivors in all groups had lower concentrations of blood urea nitrogen before continuous haemofiltration was started than non-survivors. 95%, 92%, and 90% of survivors in groups 1, 2, and 3, respectively, had full recovery of renal function. The frequency of complications was similarly low in all groups. Mortality among these critically ill patients was high, but increase in the rate of ultrafiltration improved survival significantly. We recommend that ultrafiltration should be prescribed according to patient's bodyweight and should reach at least 35 mL h(-1) kg(-1).
          Article 0 comments Cited 235 times – based on 0 reviews     Review now
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Acute renal failure in intensive care units--causes, outcome, and prognostic factors of hospital mortality; a prospective, multicenter study. French Study Group on Acute Renal Failure.

            George Kleinknecht, F Brivet, P Loirat … (1996)
            To assess the causes, the prognostic factors, and the outcome of patients with severe acute renal failure. Prospective, multicenter study. Twenty French multidisciplinary intensive care units (ICUs). All patients with severe acute renal failure were prospectively enrolled in the study for a 6-month period. Severe acute renal failure was defined by the following criteria: a) a serum creatinine concentration of > or = 3.5 mg/dL ( > or = 310 mumol/L) and/or a blood urea nitrogen concentration of > or = 100 mg/dL ( > or = 36 mmol/L); or b) an increase in blood urea nitrogen or serum creatinine concentration, such that the concentration is 100% above the baseline value in patients with previous chronic renal insufficiency (serum creatinine concentration of > 1.8 mg/dL [ > 150 mumol/L]), excluding those patients with a basal serum creatinine concentration of > 3.4 mg/dL ( > 300 mumol/L). None. Age, sex, previous health status and preexisting organ dysfunction, and type and origin of acute renal failure were recorded. The Simplified Acute Physiology Score, the Acute Physiology and Chronic Health Evaluation (APACHE II) score, and the number of Organ System Failures were calculated on ICU day 1 and at the time of inclusion in the study. Prognostic factors were determined by univariate methods and stepwise logistic regression analysis. There were 360 patients in the study; 217 patients were admitted to the study at the time of ICU admission and 143 patients were admitted to the study after ICU admission. Only 41% of these patients were in good health 3 months before ICU entry. The reason for admission was medical in 78% of cases. The type of acute renal failure was prerenal (n = 16), renal (n = 282), or postrenal (n = 17). Renal replacement therapy was used in 174 patients. Two hundred ten (58%) patients died during the hospital stay. Using stepwide logistic regression, seven variables were predictive of death. These variables were advanced age, altered previous health status, hospitalization before ICU admission, delayed occurrence of acute renal failure, sepsis, oliguria, and severity of illness as assessed at the time of study inclusion by Simplified Acute Physiology Score, APACHE II, or Organ System Failure. The hospital mortality rate of patients with severe acute renal failure in patients requiring intensive care remains high. In order to compare patient groups in further trials concerning acute renal failure, recorded characteristics of the population should include age, previous health status, disease characteristics (initial or delayed acute renal failure, oliguria, sepsis), and the severity of the illness as assessed by physiologic scoring systems recorded at the time of study inclusion.
            Article 0 comments Cited 70 times – based on 0 reviews     Review now
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Effects of dose of dialysis on morbidity and mortality.

              Michael Breyer, N Ismail, R Hakim … (1994)
              The annual mortality rate of patients on hemodialysis in the United States is 24.3%, substantially higher than the mortality of age-matched patients in Europe and Japan. Differences in the dose of dialysis received by US patients has been proposed as an important factor contributing to this high mortality rate. We undertook a prospective effort to increase the dose of dialysis delivered to 130 patients treated at an urban dialysis center affiliated with Vanderbilt University. From 1988 to 1991 the dose of dialysis, represented by the urea kinetic modelling parameter Kt/V (K = dialyzer clearance, t = dialysis time, V = volume of distribution of urea), has been gradually increased from a dose of 0.82 +/- 0.32 to 1.33 +/- 0.23. Concurrent with this increase, there was a reduction of the gross annual mortality rate from 22.8% in 1988 to 9.1% in 1991. To account for potential differences in patient characteristics during those years, we also calculated the number of expected deaths, based on data from the United States Renal Data System. The ratio of observed to expected deaths, termed the "standardized mortality rate," decreased from a value of 1.03 in 1988 to a value of 0.611 in 1991. In addition, the number of hospital days per patient per year decreased from 15.2 d/patient/yr to 10.3 d/patient/yr. We conclude that increasing the dose of delivered dialysis decreases the hospitalization and mortality rates of hemodialysis-dependent patients.
              Article 0 comments Cited 38 times – based on 0 reviews     Review now
                Bookmark
                All references

                Author and article information

                Journal
                Journal ID (nlm-ta): Crit Care
                Title: Critical Care
                Publisher: BioMed Central (London )
                ISSN (Print): 1364-8535
                ISSN (Electronic): 1466-609X
                Publication date (Print): 2005
                Publication date (Electronic): 7 April 2005
                Volume: 9
                Issue: 3
                Pages: R266-R273
                Affiliations
                [1 ]Consultant, Department of Intensive Care, Policlinico Umberto I, Rome, Italy
                [2 ]Research fellow, Department of Nephrology, St Bortolo Hospital, Vicenza, Italy
                [3 ]Specialist registrar, Department of Nephrology, St Bortolo Hospital, Vicenza, Italy
                [4 ]Research fellow, Department of Nephrology, St Bortolo Hospital, Vicenza, Italy
                [5 ]Statistician, Department of Nephrology, St Bortolo Hospital, Vicenza, Italy
                [6 ]Research fellow, Department of Intensive Care, Policlinico Umberto I, Rome, Italy
                [7 ]Head, Department of Intensive Care, St Bortolo Hospital, Vicenza, Italy
                [8 ]Head, Department of Nephrology, St Bortolo Hospital, Vicenza, Italy
                Article
                Publisher ID: cc3517
                DOI: 10.1186/cc3517
                PMC ID: 1175890
                PubMed ID: 15987400
                SO-VID: f8189a85-2237-42a2-ba6b-85232b55cd32
                Copyright © Copyright © 2005 Ricci et al.; licensee BioMed Central Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 23 September 2004
                Date revision requested : 19 October 2004
                Date revision received : 22 February 2005
                Date accepted : 14 March 2005
                Categories
                Subject: Research

                ScienceOpen disciplines: Emergency medicine & Trauma
                Data availability:
                ScienceOpen disciplines: Emergency medicine & Trauma

                Comments

                Comment on this article

                scite_

                Similar content120

                See all similar

                Cited by7

                See all cited by

                Most referenced authors109

                See all reference authors