Efficacy and Hemodynamic Outcome of Prolonged Intermittent Renal Replacement Therapy (PIRRT) in Critically Ill Patients: A Preliminary Report
Ranistha Ratanarat MD*, Thunyarat Chaipruckmalakarn MD*, Nopparat Laowahutanont MD*, Nuttasith Larpparisuth MD*, Somkiat Vasuvattakul MD*
Affiliation : * Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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-ƒ. 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.
Results : Sixty critically ill patients with AKI were randomly assigned to undergo PIRRT, 33 patients received SLEDD and 27
patients received SLEDD-ƒ. 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-ƒ 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.
Conclusion : The 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.
Keywords : Acute kidney injury (AKI), Prolonged intermittent renal replacement therapy (PIRRT), Sustained low-efficiency daily dialysis (SLEDD), Sustained low-efficiency daily diafiltration (SLEDD-ƒ), Critically ill patient
