Browsing by Author "Ronco, C."
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- Delivered dose of renal replacement therapy and mortality in critically ill patients with acute kidney injuryPublication . Vesconi, S.; Cruz, D.; Fumagalli, R.; Kindgen-Milles, D.; Monti, G.; Marinho, A.; Mariano, F.; Formica, M.; Marchesi, M.; René, R.; Livigni, S.; Ronco, C.Introduction The optimal dialysis dose for the treatment of acute kidney injury (AKI) is controversial. We sought to evaluate the relationship between renal replacement therapy (RRT) dose and outcome. Methods We performed a prospective multicentre observational study in 30 intensive care units (ICUs) in eight countries from June 2005 to December 2007. Delivered RRT dose was calculated in patients treated exclusively with either continuous RRT (CRRT) or intermittent RRT (IRRT) during their ICU stay. Dose was categorised into more-intensive (CRRT ≥ 35 ml/kg/hour, IRRT ≥ 6 sessions/week) or less-intensive (CRRT < 35 ml/kg/hour, IRRT < 6 sessions/week). The main outcome measures were ICU mortality, ICU length of stay and duration of mechanical ventilation. Results Of 15,200 critically ill patients admitted during the study period, 553 AKI patients were treated with RRT, including 338 who received CRRT only and 87 who received IRRT only. For CRRT, the median delivered dose was 27.1 ml/kg/hour (interquartile range (IQR) = 22.1 to 33.9). For IRRT, the median dose was 7 sessions/week (IQR = 5 to 7). Only 22% of CRRT patients and 64% of IRRT patients received a more-intensive dose. Crude ICU mortality among CRRT patients were 60.8% vs. 52.5% (more-intensive vs. less-intensive groups, respectively). In IRRT, this was 23.6 vs. 19.4%, respectively. On multivariable analysis, there was no significant association between RRT dose and ICU mortality (Odds ratio (OR) moreintensive vs. less-intensive: CRRT OR = 1.21, 95% confidence interval (CI) = 0.66 to 2.21; IRRT OR = 1.50, 95% CI = 0.48 to 4.67). Among survivors, shorter ICU stay and duration of mechanical ventilation were observed in the more-intensive RRT groups (more-intensive vs. less-intensive for all: CRRT (median): 15 (IQR = 8 to 26) vs. 19.5 (IQR = 12 to 33.5) ICU days, P = 0.063; 7 (IQR = 4 to 17) vs. 14 (IQR = 5 to 24) ventilation days, P = 0.031; IRRT: 8 (IQR = 5.5 to 14) vs. 18 (IQR = 13 to 35) ICU days, P = 0.008; 2.5 (IQR = 0 to 10) vs. 12 (IQR = 3 to 24) ventilation days, P = 0.026). Conclusions After adjustment for multiple variables, these data provide no evidence for a survival benefit afforded by higher dose RRT. However, more-intensive RRT was associated with a favourable effect on ICU stay and duration of mechanical ventilation among survivors. This result warrants further exploration. Trial Registration Cochrane Renal Group (CRG110600093).
- Study protocol: the DOse REsponse Multicentre International collaborative initiative (DO-RE-MI).Publication . Kindgen-Milles, D.; Journois, D.; Fumagalli, R.; Vesconi, S.; Maynar, J.; Marinho, A.; Bolgan, I.; Brendolan, A.; Formica, M.; Livigni, S.; Maio, M.; Marchesi, M.; Mariano, F.; Monti, G.; Moretti, E.; Silengo, D.; Ronco, C.We found 1 article by title matching your search: Crit Care. 2005 Aug;9(4):R396-406. Epub 2005 Jun 14. Study protocol: the DOse REsponse Multicentre International collaborative initiative (DO-RE-MI). Kindgen-Milles D, Journois D, Fumagalli R, Vesconi S, Maynar J, Marinho A, Bolgan I, Brendolan A, Formica M, Livigni S, Maio M, Marchesi M, Mariano F, Monti G, Moretti E, Silengo D, Ronco C. Anesthesiology Clinic, University of Düsseldorf, Germany. Kindgen-Milles@med.uni-duesseldorf.de Abstract INTRODUCTION: Current practices for renal replacement therapy in intensive care units (ICUs) remain poorly defined. The DOse REsponse Multicentre International collaborative initiative (DO-RE-MI) will address the issue of how the different modes of renal replacement therapy are currently chosen and performed. Here, we describe the study protocol, which was approved by the Scientific and Steering Committees. METHODS: DO-RE-MI is an observational, multicentre study conducted in ICUs. The primary end-point will be the delivered dose of dialysis, which will be compared with ICU mortality, 28-day mortality, hospital mortality, ICU length of stay and number of days of mechanical ventilation. The secondary end-point will be the haemodynamic response to renal replacement therapy, expressed as percentage reduction in noradrenaline (norepinephrine) requirement. Based on the the sample analysis calculation, at least 162 patients must be recruited. Anonymized patient data will be entered online in electronic case report forms and uploaded to an internet website. Each participating centre will have 2 months to become acquainted with the electronic case report forms. After this period official recruitment will begin. Patient data belong to the respective centre, which may use the database for its own needs. However, all centres have agreed to participate in a joint effort to achieve the sample size needed for statistical analysis. CONCLUSION: The study will hopefully help to collect useful information on the current practice of renal replacement therapy in ICUs. It will also provide a centre-based collection of data that will be useful for monitoring all aspects of extracorporeal support, such as incidence, frequency, and duration. PMID: 16137353 [PubMed - indexed for MEDLINE]PMCID: PMC1269446Free PMC Article Images from this publication.See all images (4) Free text Figure 1Flowchart of the DO-RE-MI observational study. All incident patients admitted to the intensive care unit (ICU) and requiring renal replacement therapy (RRT) will be followed up during RRT. At discharge, primary and secondary end-points will be recorded. All data will be entered in electronic case re...Study protocol: The DOse REsponse Multicentre International collaborative initiative (DO-RE-MI)Crit Care. 2005;9(4):R396-R406.
- Wearable artificial kidney and wearable ultrafiltration device vascular access-future directionsPublication . Castro, Ana; Neri, M.; Nayak Karopadi, A.; Lorenzin, A.; Marchionna, N.; Ronco, C.Background: Since 2005, three human clinical trials have been performed with the Wearable Artificial Kidney (WAK) and Wearable Ultrafiltration (WUF) device. The lack of an adequate vascular access (VA) has been pointed out as the main limitation to their implementation. Based on the current level of understanding, we will make the first conceptual proposal of an adequate VA suitable for the WAK and the WUF. Methods: All the literature related to WAK and WUF was reviewed. Based on eight main publications the VA major characteristics were defined: a mean blood flow of 100 mL/min; the capability to allow prolonged and frequent dialysis treatments, without interfering in activities of daily living (ADL); safe and convenient connection/disconnection systems; reduced risk of biofilm formation and coagulation; high biocompatibility. A research was done in order to answer to each necessary technological prerequisites. Results: The use of a device similar to a CVC with a 5Fr lumen, seems to be the most feasible option. Totally subcutaneous port devices, like the LifeSite(R) or Dialock (R) systems can be a solution to allow WAK or WUF to operate continuously while patients carry out their ADL. Recently, macromolecules that reduce the risk of thrombosis and infection and are integrated into a CVC have been developed and have the capability of overcoming these major limitations. Conclusion: With an adequate VA, portable HD devices can be acceptable options to address several unmet clinical needs of HD patients.