Intermittent versus continuous renal replacement therapy in the ICU: Impact on electrolyte and acid-base balance

Shigehiko Uchino, Rinaldo Bellomo, Claudio Ronco

Research output: Contribution to journalArticleResearchpeer-review

92 Citations (Scopus)

Abstract

Objectives: The maintenance of normal serum sodium, potassium and bicarbonate concentrations is a therapeutic goal of renal replacement therapy (RRT) in acute renal failure (ARF). The aim of this study was to determine whether this goal is best achieved with intermittent hemodialysis (IHD) or continuous venovenous hemodiafiltration (CVVHDF). Design: Retrospective controlled study. Setting: Tertiary intensive care unit. Patients: Consecutive patients with ARF treated with IHD (n = 47) or CVVHDF (n = 49). Interventions: Measurement of daily morning sodium, potassium and bicarbonate concentrations after the initiation of RRT for up to 2 weeks of treatment. Measurements and results: Before RRT, abnormal (high or low) values were frequently observed for sodium (42.6% vs 39.6%; NS) potassium (23.4% vs 45.8%; NS) and bicarbonate (63.2% vs 54.3%; NS). After treatment, however, CVVHDF, but not IHD, significantly increased mean sodium concentrations (p = 0.0001). CVVHDF was also more likely to normalize the serum sodium than IHD (76.2% vs 47.8% p = 0.0001). The mean potassium concentrations of both groups significantly decreased (p = 0.019 vs p = 0.0075, difference: NS). However, CVVHDF more frequently reduced the incidence of hypokalemia (1.9% vs 7.1%, p = 0.0006). CVVHDF but not IHD significantly increased mean bicarbonate concentrations (p = 0.016) in the first 48 h, and more frequently normalized them (71.5% vs 59.2, p = 0.0073). Conclusions: Serum sodium and potassium, and arterial bicarbonate, concentrations are frequently abnormal in ARF patients before and during renal replacement. Normalization of these values, however, is achieved more frequently with CVVHDF than with IHD.

Original languageEnglish
Pages (from-to)1037-1043
Number of pages7
JournalIntensive Care Medicine
Volume27
Issue number6
DOIs
Publication statusPublished - 30 Jul 2001
Externally publishedYes

Keywords

  • Acidosis
  • Acute renal failure
  • Continuous venovenous hemodiafiltration
  • Hyperkalemia
  • Hypokalemia
  • Hyponatremia
  • Intermittent hemodialysis
  • Renal replacement therapy

Cite this

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title = "Intermittent versus continuous renal replacement therapy in the ICU: Impact on electrolyte and acid-base balance",
abstract = "Objectives: The maintenance of normal serum sodium, potassium and bicarbonate concentrations is a therapeutic goal of renal replacement therapy (RRT) in acute renal failure (ARF). The aim of this study was to determine whether this goal is best achieved with intermittent hemodialysis (IHD) or continuous venovenous hemodiafiltration (CVVHDF). Design: Retrospective controlled study. Setting: Tertiary intensive care unit. Patients: Consecutive patients with ARF treated with IHD (n = 47) or CVVHDF (n = 49). Interventions: Measurement of daily morning sodium, potassium and bicarbonate concentrations after the initiation of RRT for up to 2 weeks of treatment. Measurements and results: Before RRT, abnormal (high or low) values were frequently observed for sodium (42.6{\%} vs 39.6{\%}; NS) potassium (23.4{\%} vs 45.8{\%}; NS) and bicarbonate (63.2{\%} vs 54.3{\%}; NS). After treatment, however, CVVHDF, but not IHD, significantly increased mean sodium concentrations (p = 0.0001). CVVHDF was also more likely to normalize the serum sodium than IHD (76.2{\%} vs 47.8{\%} p = 0.0001). The mean potassium concentrations of both groups significantly decreased (p = 0.019 vs p = 0.0075, difference: NS). However, CVVHDF more frequently reduced the incidence of hypokalemia (1.9{\%} vs 7.1{\%}, p = 0.0006). CVVHDF but not IHD significantly increased mean bicarbonate concentrations (p = 0.016) in the first 48 h, and more frequently normalized them (71.5{\%} vs 59.2, p = 0.0073). Conclusions: Serum sodium and potassium, and arterial bicarbonate, concentrations are frequently abnormal in ARF patients before and during renal replacement. Normalization of these values, however, is achieved more frequently with CVVHDF than with IHD.",
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Intermittent versus continuous renal replacement therapy in the ICU : Impact on electrolyte and acid-base balance. / Uchino, Shigehiko; Bellomo, Rinaldo; Ronco, Claudio.

In: Intensive Care Medicine, Vol. 27, No. 6, 30.07.2001, p. 1037-1043.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Intermittent versus continuous renal replacement therapy in the ICU

T2 - Impact on electrolyte and acid-base balance

AU - Uchino, Shigehiko

AU - Bellomo, Rinaldo

AU - Ronco, Claudio

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N2 - Objectives: The maintenance of normal serum sodium, potassium and bicarbonate concentrations is a therapeutic goal of renal replacement therapy (RRT) in acute renal failure (ARF). The aim of this study was to determine whether this goal is best achieved with intermittent hemodialysis (IHD) or continuous venovenous hemodiafiltration (CVVHDF). Design: Retrospective controlled study. Setting: Tertiary intensive care unit. Patients: Consecutive patients with ARF treated with IHD (n = 47) or CVVHDF (n = 49). Interventions: Measurement of daily morning sodium, potassium and bicarbonate concentrations after the initiation of RRT for up to 2 weeks of treatment. Measurements and results: Before RRT, abnormal (high or low) values were frequently observed for sodium (42.6% vs 39.6%; NS) potassium (23.4% vs 45.8%; NS) and bicarbonate (63.2% vs 54.3%; NS). After treatment, however, CVVHDF, but not IHD, significantly increased mean sodium concentrations (p = 0.0001). CVVHDF was also more likely to normalize the serum sodium than IHD (76.2% vs 47.8% p = 0.0001). The mean potassium concentrations of both groups significantly decreased (p = 0.019 vs p = 0.0075, difference: NS). However, CVVHDF more frequently reduced the incidence of hypokalemia (1.9% vs 7.1%, p = 0.0006). CVVHDF but not IHD significantly increased mean bicarbonate concentrations (p = 0.016) in the first 48 h, and more frequently normalized them (71.5% vs 59.2, p = 0.0073). Conclusions: Serum sodium and potassium, and arterial bicarbonate, concentrations are frequently abnormal in ARF patients before and during renal replacement. Normalization of these values, however, is achieved more frequently with CVVHDF than with IHD.

AB - Objectives: The maintenance of normal serum sodium, potassium and bicarbonate concentrations is a therapeutic goal of renal replacement therapy (RRT) in acute renal failure (ARF). The aim of this study was to determine whether this goal is best achieved with intermittent hemodialysis (IHD) or continuous venovenous hemodiafiltration (CVVHDF). Design: Retrospective controlled study. Setting: Tertiary intensive care unit. Patients: Consecutive patients with ARF treated with IHD (n = 47) or CVVHDF (n = 49). Interventions: Measurement of daily morning sodium, potassium and bicarbonate concentrations after the initiation of RRT for up to 2 weeks of treatment. Measurements and results: Before RRT, abnormal (high or low) values were frequently observed for sodium (42.6% vs 39.6%; NS) potassium (23.4% vs 45.8%; NS) and bicarbonate (63.2% vs 54.3%; NS). After treatment, however, CVVHDF, but not IHD, significantly increased mean sodium concentrations (p = 0.0001). CVVHDF was also more likely to normalize the serum sodium than IHD (76.2% vs 47.8% p = 0.0001). The mean potassium concentrations of both groups significantly decreased (p = 0.019 vs p = 0.0075, difference: NS). However, CVVHDF more frequently reduced the incidence of hypokalemia (1.9% vs 7.1%, p = 0.0006). CVVHDF but not IHD significantly increased mean bicarbonate concentrations (p = 0.016) in the first 48 h, and more frequently normalized them (71.5% vs 59.2, p = 0.0073). Conclusions: Serum sodium and potassium, and arterial bicarbonate, concentrations are frequently abnormal in ARF patients before and during renal replacement. Normalization of these values, however, is achieved more frequently with CVVHDF than with IHD.

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KW - Continuous venovenous hemodiafiltration

KW - Hyperkalemia

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KW - Hyponatremia

KW - Intermittent hemodialysis

KW - Renal replacement therapy

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