1. TEMPLATE DESIGN © 2008 www.PosterPresentations.co m A CASE SERIES ANALYSIS OF RENAL OUTCOME FOR FIXED VERSUS ADJUSTABLE DOSE OF CONTINUOUS RENAL REPLACEMENT THERAPY IN CRITICALLY ILL PATIENTS WITH ACUTE KIDNEY INJURY A CASE SERIES ANALYSIS OF RENAL OUTCOME FOR FIXED VERSUS ADJUSTABLE DOSE OF CONTINUOUS RENAL REPLACEMENT THERAPY IN CRITICALLY ILL PATIENTS WITH ACUTE KIDNEY INJURY Mohammad Faisal A 1, Wan Hasnul WH 1, Nazmi Liana A 2, Fadhleena Y 3. 1 Nephrology Unit, Hospital Raja Perempuan Zainab II, Kelantan, Malaysia. 2 Clinical Research Centre, Hospital Raja Perempuan Zainab II, Kelantan, Malaysia. 3 Department of Pharmacy, Hospital Raja Perempuan Zainab II, Kelantan, Malaysia. Introduction Objectives We conducted a cross sectional study from 1 to 31 January 2015 involving 10 patients admitted to Hospital Raja Perempuan Zainab II, Kelantan with AKI that required CRRT. Among them, 4 patients were given adjustable dose of effluent fluid while another 6 patients received fixed dose of effluent fluid during treatment. Results Conclusion The findings suggested that the more economical adjustable dose of CRRT can be applied to AKI patients as it did not display any significant differences in renal outcomes. A larger trial should be carried out to further evaluate its effectiveness, safety and dosage adjustment methods. Results Table 1: Demographic data The objective of this study was to evaluate renal outcomes in patients with acute kidney injury (AKI) towards fixed dose versus adjustable dose of CRRT throughout the treatment. 1.Ronco C, Bellomo R, Homel P, Brendolan A, Dan M, Piccinni P, La Greca G. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet 2000; 356: 26–30. 2.VA/NIH Acute Renal Failure Trial Network, Palevsky PM et all, Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med 2008; 359: 7–20. 3.RENAL Replacement Therapy Study Investigators, Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, Lo S, McArthur C, McGuinness S, Myburgh J, Norton R, Scheinkestel C, Su S: Intensity of continuous renal- replacement therapy in critically ill patients. N Engl J Med 2009; 361: 1627–1638. 4.Maynar-Moliner J, Sanchez-Izquierdo-Riera JA, Herrera-Gutierrez M: Renal support in critically ill patients with acute kidney injury [letter]. N Engl J Med 2008; 359: 1960; author reply 1961–1962. 5.Plaevsky PM et al. Intensity of renal replacement therapy in acute kidney injury: perspective from within the Acute Renal Failure Trial Network Study. Crit Care 2009; 13: 310. VariableFixed dose (n=6) Adjustable dose (n=4) Age (mean)45 (SD=) years old48 (SD=) years old RaceMalay, n=6Malay, n=4 Gender Male, n=5 Female, n=1 Male, n=2 Female, n=2 Cause of AKISepsis, n=6Sepsis, n=4 Adverse effect Fixed dose (n=6) Adjustable dose (n=4) p-value Clotting16% (n=1)25% (n=1)0.12 a Death50% (n=2) 0.67 a Renal outcomesFixed dose (n=6) Adjustable dose (n=4) p-value Recovery of urine ouput16% (n=1)50% (n=2)0.79 a Improvement of creatinine level66%(n=4)75% (n=3)1.27 a Table 2: Association between fixed and adjustable dose of CRRT with adverse effect Table 3: Association between fixed and adjustable dose of CRRT with renal outcome a=chisquare Graph : Differences between gender in fixed versus adjustable dose of CRRT Number of patients Methodology a=chisquare Discussion Fixed dose of continuous renal replacement therapy (CRRT) between 20 – 35 ml/kg/hr has been shown to improve renal function and reduces mortality 1. Studies showed that lower or higher dose of CRRT were not associated with better outcomes 2. To date, the optimal dose for CRRT continues to be controversial. Practice patterns vary widely among institutions as they tend to be influenced by evidences from recent clinical trials. In 2008, Maynar- Moliner J and associates raised an intriguing question as whether fixed dose is appropriate throughout the dynamic course of AKI. Palevsky PM et al believed that the theory was untested and required meticulous evaluation.