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Katherine N Gharibian, Bruce A Mueller
Fluconazole is a renally-eliminated antifungal commonly used to treat Candida species infections. In critically-ill patients receiving prolonged intermittent renal replacement therapy (PIRRT), limited pharmacokinetic (PK) data are available to guide fluconazole dosing. We used previously-published fluconazole clearance data and PK data of critically-ill patients with acute kidney injury to develop a PK model with the goal of determining a therapeutic dosing regimen for critically-ill patients receiving PIRRT...
July 2016: Clinical Nephrology
Fahad Edrees, Tingting Li, Anitha Vijayan
Prolonged intermittent renal replacement therapy (PIRRT) is becoming an increasingly popular alternative to continuous renal replacement therapy in critically ill patients with acute kidney injury. There are significant practice variations in the provision of PIRRT across institutions, with respect to prescription, technology, and delivery of therapy. Clinical trials have generally demonstrated that PIRRT is non-inferior to continuous renal replacement therapy regarding patient outcomes. PIRRT offers cost-effective renal replacement therapy along with other advantages such as early patient mobilization and decreased nursing time...
May 2016: Advances in Chronic Kidney Disease
Rajeev A Annigeri, Venkatappa Nandeesh, Ramanathan Karuniya, Sasikumar Rajalakshmi, Ramesh Venkataraman, Nagarajan Ramakrishnan
AIM: Recent advances in dialysis therapy have made an impact on the clinical practice of renal replacement therapy (RRT) in acute kidney injury (AKI) in Intensive Care Unit (ICU). We studied the impact of RRT practice changes on outcomes in AKI in ICU over a period of 8 years. SUBJECTS AND METHODS: AKI patients requiring RRT in ICU referred to a nephrologist during two different periods (period-1: Between May 2004 and May 2007, n = 69; period-2: Between August 2008 and May 2011, n = 93) were studied...
January 2016: Indian Journal of Critical Care Medicine
Susan J Lewis, Michael B Kays, Bruce A Mueller
Pharmacokinetic/pharmacodynamic analyses with Monte Carlo simulations (MCSs) can be used to integrate prior information on model parameters into a new renal replacement therapy (RRT) to develop optimal drug dosing when pharmacokinetic trials are not feasible. This study used MCSs to determine initial doripenem, imipenem, meropenem, and ertapenem dosing regimens for critically ill patients receiving prolonged intermittent RRT (PIRRT). Published body weights and pharmacokinetic parameter estimates (nonrenal clearance, free fraction, volume of distribution, extraction coefficients) with variability were used to develop a pharmacokinetic model...
October 2016: Journal of Clinical Pharmacology
Arkom Nongnuch, Viratch Tangsujaritvijit, Andrew Davenport
Patients with acute kidney injury are generally prothrombotic, and as such prone to increased risk of clotting in extracorporeal renal replacement therapy (RRT) circuits. Although some patients may be adequately treated by intermittent RRT, however due to cardiovascular instability many patients are treated by continuous renal replacement therapy (CCRT) or prolonged intermittent renal replacement therapy (PIRRT). Clotting in the RRT circuit not only reduces the efficiency of solute clearances, affects fluid balance, but also has economic health care costs...
February 2016: Minerva Urologica e Nefrologica, the Italian Journal of Urology and Nephrology
Bianca Ballarin Albino, André Luis Balbi, Juliana Maria Gera Abrão, Daniela Ponce
Prolonged intermittent renal replacement therapy (PIRRT) has emerged as an alternative to continuous renal replacement therapy in the management of acute kidney injury (AKI) patients. This trial aimed to compare the dialysis complications occurring during different durations of PIRRT sessions in critically ill AKI patients. We included patients older than 18 years with AKI associated with sepsis admitted to the intensive care unit and using noradrenaline doses ranging from 0.3 to 0.7 µg/kg/min. Patients were divided into two groups randomly: in G1, 6-h sessions were performed, and in G2, 10-h sessions were performed...
May 2015: Artificial Organs
Ranistha Ratanarat, Thunyarat Chaipruckmalakarn, Nopparat Laowahutanont, Nuttasith Larpparisuth, Somkiat Vasuvattakul
BACKGROUND: Acute 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 METHOD: The 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...
February 2012: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
N Khanal, M R Marshall, T M Ma, P J Pridmore, A B Williams, A P N Rankin
Prolonged intermittent renal replacement therapy (PIRRT) is a recently defined acute modality for critically ill patients, and in theory combines the superior detoxification and haemodynamic stability of continuous renal replacement therapy (CRRT) with the operational convenience and low cost of intermittent haemodialysis (iHD). We performed a retrospective cohort study for all critically ill adults treated with renal replacement therapy at our centre in Auckland, New Zealand from 1 January 2002 to 31 December 2008...
March 2012: Anaesthesia and Intensive Care
Andrew R Bailey, Vivian J Sathianathan, Angela L Chiew, Alastair D Paterson, Betty S H Chan, Sumesh Arora
This case report compares three types of renal replacement therapy for acute severe lithium toxicity and is the first to use prolonged intermittent renal replacement therapy (PIRRT). A peak lithium level of 13.2mmol/L was recorded after a 51- year-old man attempted suicide. He was treated with intermittent haemodialysis (IHD), PIRRT and continuous venovenous haemofiltration (CVVH) over 55 hours. Lithium clearance was shown to be comparable between IHD and PIRRT, both of which were superior to CVVH. Expected efficacy of treatment with a single daily session of PIRRT was higher than IHD or CVVH...
June 2011: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
Mark R Marshall, Julie M Creamer, Michelle Foster, Tian M Ma, Susan L Mann, Enrico Fiaccadori, Umberto Maggiore, Brent Richards, Vanessa L Wilson, Anthony B Williams, Alan P N Rankin
BACKGROUND: Prolonged intermittent renal replacement therapy (PIRRT) is a dialysis modality for critically ill patients that in theory combines the superior detoxification and haemodynamic stability of the continuous renal replacement therapy (CRRT) with the operational convenience, reduced haemorrhagic risk and low cost of conventional intermittent haemodialysis. However, the extent to which PIRRT should replace these other modalities is uncertain because comparative studies of mortality are lacking...
July 2011: Nephrology, Dialysis, Transplantation
R Bellomo, I Baldwin, N Fealy
OBJECTIVE: To present a review on the use of prolonged intermittent renal replacement therapy in the intensive care patient. DATA SOURCES: Articles and abstracts reporting the use of renal replacement therapy. SUMMARY OF REVIEW: Standard intermittent haemodialysis (IHD) has significant shortcomings in the treatment of the acute renal failure (ARF) of critical illness. These shortcomings include haemodynamic instability, the need to remove excess fluid over a short period of time, the episodic nature of small solute control, the limited ability to achieve middle molecular weight solute control and the episodic nature of acid-base control...
December 2002: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
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