Intermittent hemodialysis

Renal failure receiving intermittent hemodialysis (IHD) Renal failure receiving continuous ambulatory peritoneal 1-1-13 g/kg... 

Dialysis - Cefotetan is dialyzable for patients undergoing intermittent hemodialysis, give % of the usual recommended dose every 24 hours on days between dialysis and % of the usual recommended dose on the day of dialysis. 

A 42-year-old man developed nausea and vomiting and felt suicidal. He had type 2 diabetes and was taking metformin (56). His blood lactate concentration was 8.9 mmol/1, bicarbonate 16 mmol/1, and pH 7.2. Severe hypotension required intensive care. The lactate concentration rose to 22 mmol/1 and the bicarbonate fell to 6.7 mmol/1 and the pH to 6.89. The metformin concentration was high at 191 mg/1. He survived, having been treated with intermittent hemodialysis. 

A 64-year-old African-American man developed worsening renal insufficiency, raised creatine kinase activity, diffuse muscle pain, and severe muscle weakness. He had been taking simvastatin for about 6 months and clarithromycin for sinusitis for about 3 weeks. He was treated aggressively with intravenous hydration, sodium bicarbonate, and hemodialysis. A muscle biopsy showed necrotizing myopathy secondary to a toxin. He continued to receive intermittent hemodialysis until he died from infectious complications 3 months after admission. 

Some of the renal replacement therapies listed in Table 6.2 incorporate continuous hemodialysis or a combination of continuous hemofiltration and hemodialysis. Continuous hemodialysis differs importantly from conventional intermittent hemodialysis in that the flow rate of dialysate is much lower than is countercurrent blood flow through the dialyzer. As a result/ concentrations of many solutes in dialysate leaving the dialyzer (Cd) will have nearly equilibrated with their plasma concentrations in blood entering the dialyzer (Cp) (16/31). The extent to which this equilibration is complete is referred to as the dialysate saturation (Sd) and is calculated as the following ratio ... 

In contrast with intermittent hemodialysis in which dialyzer blood flow is rate limiting/ diffusive drug clearance during continuous renal replacement therapy is limited by dialysate flow (Qd)/ which typically is only 25 mL/min. Accordingly/ diffusive drug clearance (CLd) is calculated from the equation ... 

Drug doses need to be increased or supplemented for patients requiring renal replacement therapy only if CLec/ representing extracorporeal clearance from either intermittent hemodialysis or continuous renal replacement therapy/ is substantial when compared to CLr + CLjVR (Equation 6.12). Levy (34) has proposed that supplementation is needed only when CLec is greater than 30% of CL + CLjvr- Several approaches will be considered that can be used to make appropriate drug dose adjustments for patients requiring renal replacement therapy. 

Estimates of MDMF for several drugs are listed in Table 6.5. With the exception of vancomycin, baseline drug clearance values for functionally anephric patients (CL nepfi) are taken from either the intermittent hemodialysis or the continuous renal replacement references that are cited. In the first 2 weeks after the onset of acute renal failure, vancomycin CLamph falls from approximately 40 mL/min to the value of 6.0 mL/min that is found in patients with chronic renal failure (37). This latter value is included in Table 6.5... 

A 73-year-old man with acute respiratory failure, presumed to be secondary to amiodarone toxicity, developed sepsis and acute renal insufficiency, and required intermittent hemodialysis. Following a Herpes simplex labialis infection he was treated with oral aciclovir (400 mg tds). The next day he became sleepy, disoriented, and agitated. Over the next 48 hours his neurological condition deteriorated and he responded to pain... 

The merits of intermittent hemodialysis are many. Hemodialysis machines usually are available at hospitals and health care workers are familiar with their use. Hemodialysis treatments usually last 3 to 4 hours, so they can be done during work hours when hospitals are... 

Some clinicians believe that CRRTs are preferable to intermittent hemodialysis because they provide more consistent fluid and waste product removal. Others suggest that intermittent hemodialysis is preferable because nursing and medical staff are more familiar with its use and round-the-clock nursing is not needed. 

Schortgen F, Soubrier N, Delclauz C, et al. Hemodynamic tolerance of intermittent hemodialysis in critically ill patients. Am J Respir Crit Care Med 2000 162 197-202. 

In addition to patient-specific differences, there are marked differences between intermittent hemodialysis and the three primary types of CRRT continuous arteriovenous or venovenous hemofiltration (CAVH/CVVH), continuous arteriovenous or venovenous hemodialysis (CAVHD/CVVHD), and continuous arteriovenous or venovenous hemodiaflltration (CAVHDF/CVVHDF) with regard to drug removal." ... 

Veltri MA, Neu AM, Fivush BA, et al. Drug dosing during intermittent hemodialysis and continuous renal replacement therapy special considerations in pediatric patients. Paediatr Drugs 2004 6 45-65. 

Aluminium monitoring is of vital importance to patients with chronic renal failure being treated with intermittent hemodialysis. Aluminium sources in these patients are dialysate contamination and the ingestion of aluminium-containing medications. The development of unbiased and precise methods, for the determination of aluminium in biological materials is crucial to monitoring these hemodialysis patients after areas of aluminium toxicity. 

Iatrogenic aluminium poisoning is now one of the most important clinical problems involving trace metal toxicity. Several thousand determinations are performed daily around the world in order to monitor exposure to aluminium in patients with chronic renal failure being treated with intermittent hemodialysis. 

It is apparent that more detailed information is needed of aluminium distribution in the plasma of normals and patients on chronic intermittent hemodialysis. Such information would clarify the variability of reports on aluminium loading during hemodialysis. Recent work in the authors laboratory (King et al., 1982 1979) has been directed towards an attempt to separate aluminium species in plasma into more than just ultrafiltrable and protein-bound fractions. The approach used to define the plasma distribution and binding of aluminium was to employ gel filtration under equilibrium conditions which was a technique used previously in our laboratory for studying the distribution of calcium in plasma CToffaletti et al., 1977). 

The normal dose of ezetimibe is 10 mg once daily. Dosage reduction for patients with renal impairment, intermittent hemodialysis, or mild hepatic impairment is not necessary. Because of insufficient data, the use of ezetimibe is not recommended in patients with moderate to severe hepatic impairment (15,20,21). 

Indications for renal replacement therapy in the acute setting and for other disease processes are different from those for ESRD. A common mode of ESRD therapy in the outpatient setting is intermittent hemodialysis (IHD) where a patient receives intense treatment over the course of a few hours several times a week. Acute renal failure in the inpatient setting is often treated with continuous renal replacement therapy (CRRT), which is applied for the entire duration of the patient s clinical need and relies upon hemofiltration to a higher degree than IHD (Meyer, 2000). Other nonrenal indications for CRRT are based on the theoretical removal of inflammatory mediators or toxins and elimination of excess fluid (Schetz, 1999). These illnesses include sepsis and systemic inflammatory response syndrome, acute respiratory distress syndrome, congestive heart failure with volume overload, tumor lysis syndrome, crush injury, and genetic metabolic disturbances (Schetz, 1999). 

Hematologic In a review of 122 reports of the outcomes of the use of danaparoid in intermittent hemodialysis in severely ill patients with adverse reactions to heparin, including 97 with heparin-induced thrombocytopenia, there were only 4 reports of non-fatal major bleeds [3l ]. 

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