Acute renal failure (ARF) has been the subject of increased attention. While comorbid factors affect patient outcome, the impact of nutrition, timing of initial support or acute dialytic dosing have not been adequately evaluated. Dialysis frequency has been derived from the stable End Stage Renal Failure population. Dialysis dosage measurements, which include patient-side surrogate marker (urea) toxin levels (Time averaged concentration-TACurea), marker substance removed (Solute removal Index (SRI), or the fractional clearance of urea for the dialysis session (Kwurea), have never been established in acute renal failure. While the ESRD Pt is at steady urea generation (G) and has a known urea space (V), the pt with ARF has large swings in G and enormous V variations. Also, the use of continuous hemodialytic modalities have not been subject to dosing evaluation. As a participant in an interactive Research Project Grant (IRPG), this study will establish a methodology describing dose delivery of either intermittent or continuous dialysis support to pts with ARF. The method will be used to investigate a possible link between delivered dialysis dose and pt outcome. All ICU pts with ARF requiring dialytic support will be targeted during the observational period (phase I). Demographic and comorbidity data will be gathered, and acuity scoring systems will classify each patient. Residual renal function (creatinine clearance or iothalamate clearance) will be measured. Dialysis support will be offered via ~customary~ prescription (with uniformed dialysis membrane and dialysate composition) as either intermittent hemodialysis (IHD) or continuous venovenous hemodialysis (CWHD). Each dialysis period will be described using urea by clearance-based (Kwurea derived from equilibrated urea kinetics), mass transfer-based (SRIurea derived from direct dialysate quantification (DDQ)), or resulting pt-based (TACurea) methodology. [Different collection techniques will be evaluated for direct dialysate quantification. Further a unified method of describing dialysis delivery based upon equivalent renal clearance [ekr] will be developed.] Gurea will be measured using normalized protein catabolic rates, while total body water (Vurea) will be measured using normalized protein catabolic rates, while total body water (Vurea) will be both calculated from DDQ and attempted to be measured by Bio-electrical impedance analysis (BIA) or DEXA scanning. [A final six month feasibility period will be utilized to establish the practicality, functionality and applicability of the unified mathematical algorithm used to monitor and readjust the dialysis prescription. Give a pre=determined aggressive eKRurea, compliance with the protocol, and impediments in achieving full implementation will be determined. It is expected that this project, along with the other IRPG generated data, will provide the building blocks for the design and implementation of future multi-centered interventional trials in Acute Renal Failure.]

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project (R01)
Project #
1R01DK053411-01A1
Application #
2677947
Study Section
Special Emphasis Panel (ZRG4-ORTH (01))
Project Start
1998-08-01
Project End
2002-07-31
Budget Start
1998-08-01
Budget End
1999-07-31
Support Year
1
Fiscal Year
1998
Total Cost
Indirect Cost
Name
Cleveland Clinic Lerner
Department
Type
DUNS #
017730458
City
Cleveland
State
OH
Country
United States
Zip Code
44195
Claure-Del Granado, Rolando; Macedo, Etienne; Soroko, Sharon et al. (2014) Anticoagulation, delivered dose and outcomes in CRRT: The program to improve care in acute renal disease (PICARD). Hemodial Int 18:641-9
Claure-Del Granado, Rolando; Macedo, Etienne; Chertow, Glenn M et al. (2012) Toward the optimal dose metric in continuous renal replacement therapy. Int J Artif Organs 35:413-24
Claure-Del Granado, Rolando; Macedo, Etienne; Chertow, Glenn M et al. (2011) Effluent volume in continuous renal replacement therapy overestimates the delivered dose of dialysis. Clin J Am Soc Nephrol 6:467-75
Mehta, Ravindra L; Bouchard, Josée; Soroko, Sharon B et al. (2011) Sepsis as a cause and consequence of acute kidney injury: Program to Improve Care in Acute Renal Disease. Intensive Care Med 37:241-8
Bouchard, Josée; Macedo, Etienne; Soroko, Sharon et al. (2010) Comparison of methods for estimating glomerular filtration rate in critically ill patients with acute kidney injury. Nephrol Dial Transplant 25:102-7
Macedo, Etienne; Bouchard, Josee; Soroko, Sharon H et al. (2010) Fluid accumulation, recognition and staging of acute kidney injury in critically-ill patients. Crit Care 14:R82
Khosla, Nitin; Soroko, Sharon B; Chertow, Glenn M et al. (2009) Preexisting chronic kidney disease: a potential for improved outcomes from acute kidney injury. Clin J Am Soc Nephrol 4:1914-9
Bouchard, Josée; Soroko, Sharon B; Chertow, Glenn M et al. (2009) Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury. Kidney Int 76:422-7
Kanagasundaram, Nigel S; Greene, Tom; Larive, Armand B et al. (2008) Dosing intermittent haemodialysis in the intensive care unit patient with acute renal failure--estimation of urea removal and evidence for the regional blood flow model. Nephrol Dial Transplant 23:2286-98
Liu, Kathleen D; Himmelfarb, Jonathan; Paganini, Emil et al. (2006) Timing of initiation of dialysis in critically ill patients with acute kidney injury. Clin J Am Soc Nephrol 1:915-9

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