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Effluent volume and dialysis dose in CRRT: time for reappraisal

Nature Reviews Nephrology volume 8, pages 57–60 (2012)Cite this article

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Abstract

The results of several studies assessing dialysis dose have dampened the enthusiasm of clinicians for considering dialysis dose as a modifiable factor influencing outcomes in patients with acute kidney injury. Powerful evidence from two large, multicenter trials indicates that increasing the dialysis dose, measured as hourly effluent volume, has no benefit in continuous renal replacement therapy (CRRT). However, some important operational characteristics that affect delivered dose were not evaluated. Effluent volume does not correspond to the actual delivered dose, as a decline in filter efficacy reduces solute removal during therapy. We believe that providing accurate parameters of delivered dose could improve the delivery of a prescribed dose and refine the assessment of the effect of dose on outcomes in critically ill patients treated with CRRT.

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Figure 1: The effect of concentration polarization and clotting on delivered dialysis dose.
Figure 2: Decline in delivered dialysis dose as a result of reduced filter efficacy.

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Authors and Affiliations

  1. Division of Nephrology, University of São Paulo, Avenida Doutor Enéas de Carvalho Aguiar 255, São Paulo, CEP 05403-000, Brazil

    Etienne Macedo

  2. School of Medicine, Universidad del Valle, Cochabamba, 4742, Casilla, Bolivia

    Rolando Claure-Del Granado

  3. Division of Nephrology, School of Medicine, University of California, 200 West Arbor Drive, San Diego, 92103, CA, USA

    Ravindra L. Mehta

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  1. Etienne Macedo
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  2. Rolando Claure-Del Granado
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  3. Ravindra L. Mehta
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All authors contributed equally to discussion of content for the article, researching data to include in the manuscript and reviewing and editing of the manuscript before submission.

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Correspondence to Ravindra L. Mehta.

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The authors declare no competing financial interests.

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Macedo, E., Claure-Del Granado, R. & Mehta, R. Effluent volume and dialysis dose in CRRT: time for reappraisal. Nat Rev Nephrol 8, 57–60 (2012). https://doi.org/10.1038/nrneph.2011.172

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