Prolonged Intermittent Kidney Replacement Therapy Reviewed by Drs. Zoey Levine and Anitha Vijayan in CJASN Special Series

Zoey Levine, MD, 2nd-year renal fellow, is co-author of kidney replacement therapy review in CJASN Critical Care Nephrology and AKI.

WashU Nephrology fellow Zoey Levine, MD, and Professor of Medicine Anitha Vijayan, MD, FASN, discuss the option of prolonged intermittent kidney replacement therapy (PIKRT) in the management of patients with kidney failure in a review published in CJASN’s special series Critical Care Nephrology and Acute Kidney Injury (AKI).  

PIKRT is a hybrid form of kidney replacement therapy (KRT) that provides clearance for a longer period than a standard hemodialysis (HD) session of 3–4 hours, but still of intermittent duration unlike continuous KRT (CKRT). 

Nocturnal PIKRT was started at Barnes-Jewish Hospital by Dr. Vijayan and acute dialysis staff in 2006.  It has been widely used at our institution since then as a transition therapy from CKRT to intermittent HD and to alleviate dialysis nursing workload.  PIKRT is becoming more prevalent worldwide, particularly in emerging countries, coming to the forefront in the U.S. during the COVID-19 pandemic as nephrologists rapidly adapted the technology at their institutions to maximize the number of patients treated with a single CKRT machine.

Anitha Vijayan, MD, FASN, is Medical Director of Acute Dialysis Services at BJH, BJH West County and The Rehabilitation Institute of St. Louis.

Drs. Levine and Vijayan explore the differences in the technology, terminology, and prescription of PIKRT using two clinical vignettes that illustrate how PIKRT may be utilized at different stages of critical illness and AKI.  They also summarize the advantages and disadvantages of hybrid therapies.

Since PIKRT is a newer modality and literature is limited, the authors suggest that large randomized controlled trials are needed to determine if it is as beneficial and cost effective as CKRT and intermittent hemodialysis, and to establish appropriate drug dosing during treatments.  They also recommend standardizing the terminology and dosing of PIKRT to ensure adequate delivery of therapy.

Read the article “Prolonged Intermittent Kidney Replacement Therapy,” published in the August 2022 edition of CJASN here.  The journal’s Critical Care Nephrology and Acute Kidney Injury special series (debuting in April 2022) covers updates on broad aspects of critical care nephrology, such as drug-induced AKI, contrast media and mechanical circulatory support, that are clinically relevant to both seasoned clinicians and trainees.  

Levine, a second-year renal fellow and first author of the review, says, “I am very grateful for the opportunity to write this article for CJASN under the guidance of my mentor, Dr. Vijayan.”

Our WashU Nephrology Fellowship Program emphasizes and encourages mentorship of fellows whether in educational activities, research, or other scholarship activities.  Find out more about us in the video below and visit our Fellowship Program webpage.

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