NDT Advance Access originally published online on May 17, 2007
Nephrology Dialysis Transplantation 2007 22(8):2304-2315; doi:10.1093/ndt/gfm190
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Machine-generated bicarbonate dialysate for continuous therapy: a prospective, observational cohort study
1Department of Nephrology and Hypertension, 2Quantitative Health Sciences and 3Section of Dialysis & Extracorporeal Therapy, Department of Nephrology and Hypertension, The Cleveland Clinic, Cleveland, OH 44195, USA
Correspondence and offprint requests to: Emil P. Paganini, MD, Section of Dialysis & Extracorporeal Therapy, Department of Nephrology and Hypertension, The Cleveland Clinic, Cleveland, OH 44195, USA. Email: paganie{at}ccf.org
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Abstract |
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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.
Keywords: acute renal failure; bicarbonate dialysate; continuous renal replacement therapy; dialysis; mortality
The authors wish it to be known that, in their opinion, the first two authors contributed equally to this work.
Received for publication: 30. 3.06
Accepted in revised form: 12. 3.07