Dosing during RRT can be challenging given the numerous factors needed to be accounted for: Should not simply be dosed for reduced GFR Nomograms developed for use in stable patients on IHD can result in significant under-dosing Drug levels should be measured to aid...
Drug Factors Protein binding:Highly protein bound drugs (e.g. warfarin, diazepam, propranolol and phenytoin) are only cleared by RRT in small amountsMolecular weight:Larger molecules cleared less effectively by diffusive therapies Therapy Factors Timing of RRT:Drugs...
Mortality remains high in critically ill patients Mortality around – 45-60% in studies RRT withheld in around 20% of patients Of those that survive to ICU discharge: If no chronic renal impairments prior to admission: Long-term RRT required in 2-11% CKD in 44% If...
Access Related Failure to obtain accessDamage to vessels and surrounding structuresRisk of venous stenosisPneumothorax / haemothoraxHaemorrhageInfectionAir EmbolismPain Anticoagulation Related BleedingHeparin induced thrombocytopeniaHypocalcaemia with citrate...
There may be a significant difference between the prescribed ‘dose’ and that which is actually delivered – estimated using clearance equations to be 73% in practice Due to a number of factors: Treatment downtime due to filter clotting Technical problems such as boor...
