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Kidney Week

Abstract: PO1237

Accelerated Renal Replacement Therapy: Single-Institution Experience in Calculating Delivered Clearance During the COVID-19 Pandemic

Session Information

Category: Trainee Case Report

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Cho, Janis, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Ahya, Shubha, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Ghossein, Cybele, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
Introduction

Continuous renal replacement therapy (CRRT) is commonly used in the intensive care unit (ICU) setting. A minimum delivered dose 20 ml/kg/hr is associated with improved survival. Previous studies have revealed significant discrepancy between prescribed and delivered CRRT dosing. Before the COVID 19 pandemic, CRRT was the main modality used at our medical center. But to accommodate the increase need for RRT and our limited resources, accelerated renal replacement therapy (ARRT), providing the same total CRRT clearance but in half the time, was used. To ensure that the delivered dose was appropriate given the reduction in time, we calculated delivered clearance.

Case Description

ARRT prescribed dose was based on patient’s weight and time on therapy to achieve the equivalent 20cc/kg/hr over 24 hours. Delivered clearance (k) was calculated using the following formula
K= Qd + Qr +Quf x FUN/BUN / weight/ 24 hours
Qd =spent dialysate Qr= replacement fluid rate and Quf = net fluid removal rate. FUN = effluent urea nitrogen BUN= blood urea nitrogen. Hourly flowsheet with total time, Quf, Qd, and Qr were recorded during treatment by bedside nurse and reviewed to calculate the delivered clearance.
8 patients underwent 14 uninterrupted AVVHDF treatments. Total treatment time ranged from 8-10.5 hours. FUN/BUN ratio ranged from 0.5 to 1.05. The ratio between delivered clearance to prescribed clearance ranged from 0.83-1.08. Only 6 treatments (43%) achieved goal clearance.

Discussion

ARRT delivered clearance was only achieved 43% of time. While ARRT is a feasible modality when resources are limited, close monitoring of achieved clearance is needed to ensure that adequate dialysis is being delivered. Careful patient selection is important as delivered dose may be more difficult to achieve in obese patients. Although ARRT may be a practical alternative, continuous therapy would be ideal in the critical setting.