Document Detail

Machine-generated bicarbonate dialysate for continuous therapy: a prospective, observational cohort study.
MedLine Citation:
PMID:  17510100     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: In 1995, we described the technique of adapting a haemodialysis (HD) machine to produce a composition-adjustable, bicarbonate-based fluid (as our primary source for dialysate) for continuous HD in intensive care unit (ICU) patients with acute renal failure (ARF). The following studies the clinical effects, biochemical changes and economic costs of this practice in a large cohort of patients at a single centre over the last 10 years. METHODS: The CCF-ARF Support Registry (1995-2001) was used to identify 405 patients initially supported with bicarbonate continuous HD. The registry is a prospective, observational cohort database that captures demographic, dialysis therapy, laboratory and outcome data. All supported ARF patients were recorded from 1995-98, and then one in five patients from 1999 to 2001. We also reviewed records of the individual dialysis procedures, dialysate disposal, dialysate monitoring tests and specific costs. RESULTS: Continuous HD was performed for 1292 +/- 587 days from 1994 to 2004. Demographics [age 59.57 +/- 14.41 years, weight 84.2 +/- 24 kg, male 65%, chronic kidney disease (CKD) 34%] and ICU mortality (60.5%) were comparable to other reported series. Day 4 solute [BUN 52.3 mg/dl (95% CI 49.6-54.9), creatinine 2.79 mg/dl (95% CI 2.64-2.95)], electrolyte and acid-base balance [bicarbonate 24.12 mmol/l (95% CI 23.7-24.6)] were well controlled. Dialysate monitoring revealed no positive cultures or elevated endotoxin levels. Variable-composition dialysate was achieved and delivered to all patients without adverse consequences. The cost of dialysate actually declined over time (1995 = $0.91/l, 2005 = $0.67/l). CONCLUSION: We have demonstrated that ICU ARF patients can be safely, effectively and economically supported with continuous HD using this source.
Boon Wee Teo; Sevag Demirjian; Kathryn H Meyer; Eugene Wright; Emil P Paganini
Publication Detail:
Type:  Journal Article     Date:  2007-05-17
Journal Detail:
Title:  Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association     Volume:  22     ISSN:  0931-0509     ISO Abbreviation:  Nephrol. Dial. Transplant.     Publication Date:  2007 Aug 
Date Detail:
Created Date:  2007-07-26     Completed Date:  2007-11-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8706402     Medline TA:  Nephrol Dial Transplant     Country:  England    
Other Details:
Languages:  eng     Pagination:  2304-15     Citation Subset:  IM    
Department of Nephrology and Hypertension, The Cleveland Clinic, Cleveland, OH 44195, USA.
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MeSH Terms
Bicarbonates / pharmacology
Cohort Studies
Dialysis Solutions / chemistry*
Glucose / metabolism
Intensive Care Units
Kidney Failure, Acute / therapy*
Middle Aged
Prospective Studies
Time Factors
Treatment Outcome
Reg. No./Substance:
0/Bicarbonates; 0/Dialysis Solutions; 0/Electrolytes; 50-99-7/Glucose

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