PIRRT may help you improve resource utilization, patient care, and early patient mobilization programs.
Prolonged Intermittent Renal Replacement Therapy ("PIRRT") is a gentle 6- to 12-hour hybrid renal replacement therapy that may be used as an alternative to renal replacement therapies in the ICU.
Early Patient Mobilization
Early patient mobilization in the ICU has been associated with improved outcomes, including reduction in ICU and hospital length of stay, more ventilator-free days, and better functional status. PIRRT can provide patients with time off therapy, allowing them to receive physical and occupational therapy. When patients no longer need 24-hour CRRT, PIRRT can help you achieve early patient mobilization goals.1
References:
- Edrees F, Li T, Vijayan A. Prolonged Intermittent Renal Replacement Therapy. Adv in Chronic Kidney Disease. 2016:23:No 3:195-202.
PIRRT vs. CRRT
PIRRT is a practical alternative to CRRT. By increasing the blood flow rate to run over a 6- to 12-hour period, higher hourly hemofiltration rates are feasible. This allows for an accelerated treatment period, yet provides a gentle therapy.1
Typical Dosing
Using approximate flow rates of 300 mL/min blood flow and a 5 L/hr prescription fluid rate, the use of PIRRT has been demonstrated to be an effective and efficient therapy.2
Potential Benefits of PIRRT vs Conventional CRRT with NxStage System One
References:
- Gashti CN, Salcedo S, Robinson V, Rodby RA. Accelerated venovenous hemofiltration: early technical and clinical experience. Am J Kidney Dis. 2008;51(5):804-810.
- Concepcion LA, et al. ARF requiring dialysis: use of shift CVVHD vs. conventional dialysis. J Am Soc Nephrol. 2009; Suppl, F-P01557 (Abstract).
- Kox WJ, et al. Practical aspects of renal replacement therapy. The International Journal of Artificial Organs, Vol. 19, No 2, 100-105, 1996.
- Davies H., et al. Maintaining the CRRT Circuit; non-anticoagulant alternatives. Australian Critical Care; Vol. 19, No. 4, November 2006
- Edrees F, Li T, Vijayan A. Prolonged Intermittent Renal Replacement Therapy. Adv in Chronic Kidney Disease. 2016:23:No 3:195-202.
PIRRT vs IHD
In a retrospective analysis of 280 patients with acute renal failure in the ICU, an 8-hour PIRRT* was demonstrated to be an effective and efficient therapy compared to conventional IHD.
Typical Dosing
Using approximate flow rates of 300 mL/min blood flow and a 5 L/hr prescription fluid rate, the use of PIRRT has been demonstrated to be an effective and efficient therapy.1
Potential Benefits of PIRRT vs Conventional IHD with NxStage System One
The compact design of the NxStage System One, with no special electrical or plumbing needs, frees up valuable space when compared to equipment required for conventional IHD (including HD system, supply cart and portable RO).
*PIRRT is also known as SHIFT Therapy
References:
- Concepcion LA, et al. ARF requiring dialysis: use of shift CVVHD vs. conventional dialysis. J Am Soc Nephrol. 2009;Suppl, F-P01557 (Abstract).
PIRRT vs. SLEDD
PIRRT is a practical alternative to SLEDD, allowing you to use one simple system to treat patients requiring renal replacement therapy in the ICU.
Typical Dosing
Using approximate flow rates of 300 mL/min blood flow and a 5 L/hr prescription fluid rate, the use of PIRRT has been demonstrated to be an effective and efficient therapy.1
Potential benefits of PIRRT vs SLEDD with NxStage® System One™
The compact design of the NxStage System One, with no special electrical or plumbing needs, frees up valuable space when compared to equipment required for conventional IHD (including HD system, supply cart, and portable RO).
References:
- Concepcion LA, et al. ARF requiring dialysis: use of shift CVVHD vs. conventional dialysis. J Am Soc Nephrol. 2009; Suppl, F-P01557 (Abstract).
Dosing Guidelines for PIRRT
Leading experts have established PIRRT dosing and antibiotic guidelines.
Dosing Guidelines
According to RENAL and ATN trials, contemporary dosing guidelines suggest 20-25 ml/kg/hr1,2
References:
- Palevsky, PM, et al (The VA/NIH Acute Renal Failure Trial Network); Intensity of Renal Support in Critical Ill Patients with Acute Kidney Injury, N Engl J Med; Vol. 359, No. 1, 2008.
- Bellomo R., et al. Intensity of Continuous Renal-Replacement Therapy in Critically Ill Patients (RENAL). NEJM 2009; 361:1627-38.
- Adapted from Diaz-Buxo, et al. Standard Kt/V: Comparison of Calculation Methods. Artificial Organs, 30(3): 178-185, 2006.
- Reported data based on the experience of one institution.
