SHIFT therapy is a gentle 6 – 12 hour renal replacement therapy that may be used as an alternative to conventional intermittent hemodialysis in the ICU or for patients transitioning from continuous therapy as they hemodynamically stabilize. Based on physician assessment, SHIFT therapy can also be a practical alternative to SLEDD and CRRT for some patients, particularly when resources are limited.


Potential benefits of SHIFT Therapy vs. Conventional IHD with NxStage System One

In a retrospective analysis of 280 patients with acute renal failure in the ICU, an 8-hour SHIFT therapy was compared to conventional IHD. Using approximate flow rates of 300 mL/min blood flow and a 5 L/hr prescription fluid rate, the use of SHIFT therapy demonstrated to be an effective and efficient therapy.

Provides patients with a gentle therapy

  • Hemodynamic stability with slower volume and solute removal1
  • Viable alternative to conventional IHD, with no increase in mortality1
  • Remove as much or more fluid with SHIFT vs IHD due to longer duration of therapy1

Maximum use of resources

  • Dialysis staff is free to care for other patients
  • Empowers ICU RN to manage the patient’s therapy schedule
  • Increases staff competencies with more frequent use of the same system for all RRT in the ICU.

Simplifies the delivery of RRT

  • Eliminates need to treat water source
  • Small size is easy to transport and takes up minimal space
  • User-friendly machine with online instruction and troubleshooting
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).

SHIFT as an Alternative to CRRT

Using an increased blood flow (250-400 mL/min) and fluid exchange rate (3-5 L/hr) over a 6 to 12 hour period allows for an accelerated renal replacement treatment, yet provides a gentle therapy. In a study of 100 patients undergoing SHIFT therapy using the NxStage System One:2

  • 85.6% of patients received the prescribed clearance
  • No anticoagulation was used and filter clotting was seen in only 3.3% of treatments
  • SHIFT therapy also allowed for greater scheduling flexibility
  • Running the therapy during the night shift, allows patients to be scheduled for other tests and procedures during the day

Risks

Renal replacement therapy, as with any medical therapy is not without risks. The decision of which therapy to use should be made by the physician, based on previous experience and on the individual facts and circumstances of the patient. There is no literature demonstrating one continuous therapy is clinically better than another.3
References:
  1. Concepcion LA, et al. ARF requiring dialysis: use of shift CVVHD vs. conventional dialysis. J Am Soc Nephrol. 2009;Suppl, F-P01557 (Abstract).
  2. 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.
  3. Kraus MA. Selection of Dialysate and Replacement Fluids and Management of Electroyte and Acid-Base Disturbances. Seminars in Dialysis. 2009;22(2):137-140.