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Table 1 PIRRT Using IHD and CRRT Machines in Comparison with Standard IHD and CRRT Prescriptions

From: How I prescribe prolonged intermittent renal replacement therapy

Parameter

Modality

Standard

Intermittent IHD

PIRRT

Standard

CRRT

Using IHD Machine

Using CRRT Machine

Clearance mode

Diffusion

Diffusion or Diffusion + Convection

Diffusion or Convection or Diffusion + Convection

Blood flow rate

 ≥ 300 mL/min

100–300 mL/min

100–200 mL/min

Duration

3–4 h

6–12 h

8–12 h

Continuous

Frequency

3–4 days/week

4–7 days/week

Dialyzate rate

500–800 mL/min

100–400 mL/min

10–30 mL/min

Replacement Rate*

N/A

1–2 L/hour

20–40 mL/min

10–30 mL/min

Dialyzer Surface area

1.0–2.5 m2

0.6–2.5 m2

0.6–1.5 m2

Need for Anticoagulation

 + 

 + 

 +  +  + 

Dialyzate [Na+]

145 mmol/Lδ

140 mmol/LΨ

Dialyzate [K+]

4 mmol/Lδ

Dialyzate [Ca + +]

1.5 mmol/Lδ

1.75 mmol/L

(0 mmol/L if using RCA) Ψ

Dialyszte [HCO3]

24 – 36 mmol/Lδ

32 mmol/LΨ

Options for pre-emptive PO4 supplementation once serum [PO4] ≤ 1–1.6 mmol/L

Add PO4 to dialyzate

Add PO4 to standard CRRT fluids or switch to commercially available PO4-containing fluids

Oral/enteral PO4 administration

  1. *Only applicable if convective clearance (hemofiltration) is being employed
  2. δStandard concentrations; may be adjusted as indicated clinically
  3. ΨUsing commercially available solutions
  4. [Na+], sodium concentration; [K+], potassium concentration; [Ca + +], calcium concentration; [HCO3], bicarbonate solution; RCA, regional citrate anticoagulation; [PO4], phosphate concentration