PRESCRIBED VERSUS DELIVERED DIALYSIS IN ACUTE-RENAL-FAILURE PATIENTS

The current study was designed first to determine separately the presc ribed and delivered dose of dialysis and, second, to determine what fa ctors lead to failure to deliver the prescribed dose of dialysis in pa tients with acute renal failure (ARF), Forty patients, who collectivel y underwent 136 dialysis treatments, were studied prospectively at two institutions. The results showed that almost half the prescriptions ( 49%) were for a KW less than 1.2 and, more importantly, nearly 70% of the treatments delivered a Kt/V less than 1.2, the minimally acceptabl e dose defined in the Dialysis Outcomes Quality Initiative (DOQI) guid elines for chronic hemodialysis (CHD) patients, Patient predialysis we ight was the most important variable associated with a low prescribed and delivered dose of dialysis, as well as lack of delivery of the pre scribed dose of dialysis, From the statistical model, it is estimated that for every 10-kg increase in predialysis weight, the chance of pre scribing or delivering a Kt/V less than 1.2 increased 4.6- and 1.95-fo ld, respectively, The lower than prescribed blood flow achieved by the temporary catheters and patients not receiving anticoagulation were v ariables also associated with not receiving the prescribed KW, It is c oncluded that patients with ARF are prescribed and receive a dose of d ialysis that would be considered inadequate for CHD patients, Until th e association between dose of dialysis and outcome is better defined, it would be prudent that both the dialysis prescription and the delive ry of dialysis to patients with ARF should be performed with the same care and goals as that currently received by patients with end-stage r enal disease (ESRD), (C) 1998 by the National Kidney Foundation, Inc.