Thread by @adequator_app

📈CRRT 📉

📝Prescription 📝
&
🔮Prediction of Delivered Dose🔮

Using the ADEQUATOR

#CRRT #nephrology #AKI #criticalnephrology @RenalFellowNtwk @adequator_app

2/8👨🏽‍💼Male 50 years old needs CRRT for volume control and AKI

- 100 kg, 170 cm height, Htct 35%

- Modality CVVHDF
- Prescribed dose 25 ml/kg/hr
- Anticoagulation: none
- Institution down time average: 2 hours
- Urea cl dose based, so we use SC of 1

3/8The calculator will give you the amount of volume “dose” to distribute:

25x100kg——>2500 ml/hr

Distribute the volume at your preference

Dialysate —————1100 ml/hr
Replacement PRE —1100 ml/hr
Replecement POST -200ml/hr
Fluid Removal ———100 ml/hr

4/8After the distribution of the dose we will get a:

“Minimum recommended Qb”

Qb at least 2.5 times de dialysate for clearance goals

Qb at least 5-6 times the replacement for filtration fraction goals

5/8 We decided to give 150 ml/min of Qb

- The next step is to account for “down time” (this is an estimation, some centers have an average)

In this case we will aoccount for 2 hour down time in a 24 total time

6/8 Finally : EFFLUENT SATURATION

When hemo filters are used, a secondary membrane develops (prot adsorption )with time and usage.

This will lower the capacity of the filter to saturate (with solutes) the effluent

When filter is new this should be 100%

7/8 Results:
100 kg male who will receive a prescribed dose of 25 ml/kg/hr using CVVHDF will get:

- Filtration fraction of 20%
- A DELIVERED dose (considering predilution effect, down time, and filter life) of 20ml/kg/hr
- Urea clearance of 34 ml/min

8/8
Even though we prescribed 25 ml/kg/hr, we got a lower delivered dose of 20.

You can play with the prescription to get better delivered dose.

See the full prescription 👇