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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 PLoS+One
2016 ; 11
(3
): e0149706
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Evaluation of Intermittent Hemodialysis in Critically Ill Cancer Patients with
Acute Kidney Injury Using Single-Pass Batch Equipment
#MMPMID26938932
Torres da Costa E Silva V
; Costalonga EC
; Oliveira AP
; Hung J
; Caires RA
; Hajjar LA
; Fukushima JT
; Soares CM
; Bezerra JS
; Oikawa L
; Yu L
; Burdmann EA
PLoS One
2016[]; 11
(3
): e0149706
PMID26938932
show ga
BACKGROUND: Data on renal replacement therapy (RRT) in cancer patients with acute
kidney injury (AKI) in the intensive care unit (ICU) is scarce. The aim of this
study was to assess the safety and the adequacy of intermittent hemodialysis
(IHD) in critically ill cancer patients with AKI. METHODS AND FINDINGS: In this
observational prospective cohort study, 149 ICU cancer patients with AKI were
treated with 448 single-pass batch IHD procedures and evaluated from June 2010 to
June 2012. Primary outcomes were IHD complications (hypotension and clotting) and
adequacy. A multiple logistic regression was performed in order to identify
factors associated with IHD complications (hypotension and clotting). Patients
were 62.2 ± 14.3 years old, 86.6% had a solid cancer, sepsis was the main AKI
cause (51%) and in-hospital mortality was 59.7%. RRT session time was 240
(180-300) min, blood/dialysate flow was 250 (200-300) mL/min and UF was 1000
(0-2000) ml. Hypotension occurred in 25% of the sessions. Independent risk
factors (RF) for hypotension were dialysate conductivity (each ms/cm, OR 0.81, CI
0.69-0.95), initial mean arterial pressure (each 10 mmHg, OR 0.49, CI 0.40-0.61)
and SOFA score (OR 1.16, CI 1.03-1.30). Clotting and malfunctioning catheters
(MC) occurred in 23.8% and 29.2% of the procedures, respectively. Independent RF
for clotting were heparin use (OR 0.57, CI 0.33-0.99), MC (OR 3.59, CI 2.24-5.77)
and RRT system pressure increase over 25% (OR 2.15, CI 1.61-4.17). Post RRT blood
tests were urea 71 (49-104) mg/dL, creatinine 2.71 (2.10-3.8) mg/dL, bicarbonate
24.1 (22.5-25.5) mEq/L and K 3.8 (3.5-4.1) mEq/L. CONCLUSION: IHD for critically
ill patients with cancer and AKI offered acceptable hemodynamic stability and
provided adequate metabolic control.
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