EXTENDED DAILY DIALYSIS

Extended daily dialysis (EDD) is becoming increasingly popular method of extracorporal substitutive therapy for patients with acute lesion of kidneys in practice of the department of intensive care (DIC). Long dialysis time (usually 8-18 hours), low flow of dialysate and blood are the key elements of EDD as a method of substitutive renal therapy. Prospective controlled investigations of patients in critical state confirm that clearance of low-molecular substances used in DIC can be compared with interrupted hemodialysis and uninterrupted veno-venous hemofiltration even when the latter was used with high speeds of liquid substitution. In addition, the cardio-vascular stability in patients with EDD was similar with that in uninterrupted methods of substitutive renal therapy. The regimen of performing daily dialysis at night has an additional use because it does not cut down the access of the DIC personnel to the patient during day, minimize the interaction of the substitutive renal therapy with other DIC procedures. Thus EDD has a combination of both intermitting hemodialysis and uninterrupted procedures, that make it a practically ideal method to treat patients with renal failure under conditions of practice of resuscitation. Although, the prospective clinical investigations have not been finished yet, all the available at present data show that outcomes of treatment of the patients on EDD are not different in predicted degree of the disease from the results of treatment using uninterrupted substitutive renal therapy. Hence, many Centers of the world are already using this “hybrid” technique, using modified standard dialysis equipment. EDD also proposes sufficient possibilities for the interaction between nephrologists and resuscitators with divided responsibility. The nephrological personnel are responsible for the prescriptions, beginning and maintenance of the treatment, while specialists of DIC are responsible for monitoring, variants of ultrafiltration, complications and completion of the procedures. Such joint access to the management of the patients is optimal for the patients in critical state, where new accesses and knowledge of two specialties in DIC are used. We think that EDD will be the principal method of substitutive renal therapy in acute lesion f the kidneys in patients in critical state.

1. Kolff WJ. Lasker Clinical Medical Research Award. The artificial kidney and its effect on the development of other artificial organs. Nat Med 2002; 8: 1063-1065

2. Metnitz PG, Krenn CG, Steltzer H et al. Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. Crit Care Med 2002; 30: 2051-2058

3. Uchino S, Kellum JA, Bellomo R et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 2005; 294: 813-818

4. Mehta RL, Pascual MT, Soroko S et al. Spectrum of acute renal failure in the intensive care unit: the PICARD experience. Kidney Int 2004; 66: 1613-1621

5. Schortgen F, Soubrier N, Delclaux C et al. Hemodynamic tolerance of intermittent hemodialysis in critically ill patients: usefulness of practice guidelines. Am J Respir Crit Care Med 2000; 162: 197-202

6. Augustine JJ, Sandy D, Seifert TH, Paganini EP. A randomized controlled trial comparing intermittent with continuous dialysis in patients with ARF. Am J Kidney Dis 2004; 44: 1000-1007

7. Uehlinger DE, Jakob SM, Ferrari P et al. Comparison of continuous and intermittent renal replacement therapy for acute renal failure. Nephrol Dial Transplant 2005; 20: 1630-1637

8. Ronco C, Bellomo R, Homel P et al. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet 2000; 356: 26-30

9. Schiffl H, Lang SM, Fischer R. Daily hemodialysis and the outcome of acute renal failure. N Engl J Med 2002; 346: 305-310

10. Berbece AN, Richardson RM. Sustained low-efficiency dialysis in the ICU: cost, anticoagulation, and solute removal. Kidney Int 2006; 70: 963-968

11. Fiaccadori E, Maggiore U, Rotelli C et al. Removal of linezolid by conventional intermittent hemodialysis, sustained low-efficiency dialysis, or continuous venovenous hemofiltration in patients with acute renal failure. Crit Care Med 2004; 32: 2437-2442

12. Kielstein JT, Kretschmer U, Ernst T et al. Efficacy and cardiovascular tolerability of extended dialysis in critically ill patients: a randomized controlled study. Am J Kidney Dis 2004; 43: 342-349

13. Kumar VA, Craig M, Depner TA, Yeun JY. Extended daily dialysis: A new approach to renal replacement for acute renal failure in the intensive care unit. Am J Kidney Dis 2000; 36: 294-300

14. Kumar VA, Yeun JY, Depner TA, Don BR. Extended daily dialysis vs. continuous hemodialysis for ICU patients with acute renal failure: a two-year single center report. Int J Artif Organs 2004; 27: 371-379

15. Lonnemann G, Floege J, Kliem V et al. Extended daily veno-venous high-flux haemodialysis in patients with acute renal failure and multiple organ dysfunction syndrome using a single path batch dialysis system. Nephrol Dial Transplant 2000; 15: 1189-1193

16. Marshall MR, Golper TA, Shaver MJ, Chatoth DK. Hybrid renal replacement modalities for the critically ill. Contrib Nephrol 2001; 252-257

17. Marshall MR, Golper TA, Shaver MJ et al. Urea kinetics during sustained low-efficiency dialysis in critically ill patients requiring renal replacement therapy. Am J Kidney Dis 2002; 39: 556-570

18. Naka T, Baldwin I, Bellomo R et al. Prolonged daily intermittent renal replacement therapy in ICU patients by ICU nurses and ICU physicians. Int J Artif Organs 2004; 27: 380-387

19. Ratanarat R, Brendolan A, Volker G et al. Phosphate kinetics during different dialysis modalities. Blood Purif 2005; 23: 83-90

20. Schlaeper C, Amerling R, Manns M, Levin NW. High clearance continuous renal replacement therapy with a modified dialysis machine. Kidney Int Suppl 1999; 72: S20-S23

21. Marshall MR, Golper TA, Shaver MJ et al. Sustained low-efficiency dialysis for critically ill patients requiring renal replacement therapy. Kidney Int 2001; 60: 777-785

22. Hall FS, Shaver MJ, Marshall MR. Daily 12-hour sustained low-efficiency hemodialysis (SLED): A nursing perspective. Blood Purif 1999; 17: 36 A

23. Liao Z, Zhang W, Hardy PA et al. Kinetic comparison of different acute dialysis therapies. Artif Organs 2003; 27: 802-807

24. Eloot S, Van Biesen W, Dhondt A et al. Impact of hemodialysis duration on the removal of uremic retention solutes.Kidney Int 2007

25. Palevsky PM, O’Connor T, Zhang JH et al. Design of the VA/NIH Acute Renal Failure Trial Network (ATN) Study: intensive versus conventional renal support in acute renal failure. Clin Trials 2005; 2: 423-435

26. Davenport A, Bouman C, Kirpalani A et al. Delivery of renal replacement therapy in acute kidney injury: What are the key issues? Clin J Am Soc Nephrol 2008

27. Morgera S, Scholle C, Melzer C et al. A simple, safe and effective citrate anticoagulation protocol for the genius dialysis system in acute renal failure. Nephron Clin Pract 2004; 98: c35-c40

28. Marshall MR, Ma T, Galler D et al. Sustained low-efficiency daily diafiltration (SLEDD-f) for critically ill patients requiring renal replacement therapy: towards an adequate therapy. Nephrol Dial Transplant 2004; 19: 877-884

29. Barenbrock M, Hausberg M, Matzkies F et al. Effects of bicarbonate- and lactate-buffered replacement fluids on cardiovascular outcome in CVVH patients.Kidney Int 2000; 58: 1751-1757

30. van der Sande FM, Kooman JP, Konings CJ, Leunissen KM. Thermal effects and blood pressure response during postdilution hemodiafiltration and hemodialysis: the effect of amount of replacement fluid and dialysate temperature. J Am Soc Nephrol 2001; 12: 1916-1920

31. Kanagasundaram NS, Larive AB, Paganini EP. A preliminary survey of bacterial contamination of the dialysate circuit in continuous veno-venous hemodialysis. Clin Nephrol 2003; 59: 47-55

32. Burkhardt O, Joukhadar C, Traunmuller F et al. Elimination of daptomycin in a patient with acute renal failure undergoing extended daily dialysis. J Antimicrob Chemother 2008; 61: 224-225

33. Czock D, Husig-Linde C, Langhoff A et al. Pharmacokinetics of moxifloxacin and levofloxacin in intensive care unit patients who have acute renal failure and undergo extended daily dialysis. Clin J Am Soc Nephrol 2006; 1: 1263-1268

34. Kielstein JT, Stadler M, Czock D et al. Dialysate concentration and pharmacokinetics of 2F-Ara-A in a patient with acute renal failure. Eur J Haematol 2005; 74: 533-534

35. Kielstein JT, Czock D, Schopke T et al. Pharmacokinetics and total elimination of meropenem and vancomycin in intensive care unit patients undergoing extended daily dialysis. Crit Care Med 2006; 34: 51-56

36. Kielstein JT, Schwarz A, Arnavaz A et al. High-flux hemodialysis—an effective alternative to hemoperfusion in the treatment of carbamazepine intoxication. Clin Nephrol 2002; 57: 484-486

37. Kielstein JT, Woywodt A, Schumann G et al. Efficiency of high-flux hemodialysis in the treatment of valproic acid intoxication. J Toxicol Clin Toxicol 2003; 41: 873-876

38. Kielstein JT, Linnenweber S, Schoepke T, Fliser D. One for all–a multi-use dialysis system for effective treatment of severe thallium intoxication. Kidney Blood Press Res 2004; 27: 197-199

39. Dhondt A, Verstraete A, Vandewoude K et al. Efficiency of the Genius batch hemodialysis system with low serum solute concentrations: the case of lithium intoxication therapy. Am J Kidney Dis 2005; 46: e95-e99

40. Alam M, Marshall M, Shaver M, Chatoth D. Cost comparison between sustained low efficiency hemodialysis (SLED) and continuous venovenous hemofiltration (CVVH) for ICU patients with ARF. Am J Kidney Dis 2000; 35: A9

41. Ma T, Walker JA, Eggleton K, Marshall M. Cost comparison between sustained low efficiency daily dialysis / diafiltration (SLEDD) and continuous renal replacement therapy for ICU patients with ARF. Nephrology (Carlton)7, A54. 2002. Abstract

42. Golper TA. Hybrid renal replacement therapies for critically ill patients. Contrib Nephrol 2004; 144: 278-283

43. Lameire N, Van Biesen W, Vanholder R. Dialysing the patient with acute renal failure in the ICU: the emperor’s clothes? Nephrol Dial Transplant 1999; 14: 2570-2573

44. Mehta RL, McDonald B, Gabbai F et al. Nephrology consultation in acute renal failure: does timing matter? Am J Med 2002; 113: 456-461