• J Med Assoc Thai · Feb 2012

    Randomized Controlled Trial

    Efficacy and hemodynamic outcome of prolonged intermittent renal replacement therapy (PIRRT) in critically ill patients: a preliminary report.

    • Ranistha Ratanarat, Thunyarat Chaipruckmalakarn, Nopparat Laowahutanont, Nuttasith Larpparisuth, and Somkiat Vasuvattakul.
    • Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. ranittha@hotmail.com
    • J Med Assoc Thai. 2012 Feb 1;95 Suppl 2:S265-71.

    BackgroundAcute kidney injury (AKI) is frequently part of a multiple-organ dysfunction syndrome presenting in critically ill patients. Prolonged intermittent renal replacement therapy (PIRRT) provides the advantages of both continuous renal replacement therapy (CRRT) in term of hemodynamic stability and the cost-effectiveness of intermittent hemodialysis (IHD). This study aims to study PIRRT in the aspects of efficacy and hemodynamic outcomes.Material And MethodThe authors present a single-center experience accumulated over 20 months from February 2009 to September 2010 with two PIRRT techniques, called SLEDD and SLEDD-f. Eight-hour treatments were performed daily for three consecutive days. Hemodynamic parameters were recorded at different time points and blood samples were taken for urea and solute clearance before and after treatment.ResultsSixty critically ill patients with AKI were randomly assigned to undergo PIRRT 33 patients received SLEDD and 27 patients received SLEDD-f. Our results demonstrate significant decrease in BUN, creatinine, serum potassium and phosphate in both PIRRT techniques. Moreover with the use of similar filters and blood flow rates, SLEDD-f was comparable with SLEDD in terms of small solute clearance and detoxification. For hemodynamic outcomes, the authors found that MAP increased after completion of the first session of PIRRT and along the three consecutive days of daily PIRRT, together with the gradual improvement of vasopressor scores.ConclusionThe prolonged intermittent renal replacement therapy (PIRRT) appears to be an outstanding technique for treatment of critically ill patients with AKI and it also seems to have cost effectiveness. Moreover it is suitable to a limited resource region such as Thailand.

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