Prolonged Intermittent Renal Replacement Therapy (“PIRRT”) 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, PIRRT can also be a practical alternative to SLEDD and CRRT for some patients, particularly when resources are limited.
Potential benefits of PIRRT vs. Conventional IHD with NxStage System OneIn a retrospective analysis of 280 patients with acute renal failure in the ICU, an 8-hour PIRRT* 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 PIRRT 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 PIRRT 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
*PIRRT is also known as SHIFT Therapy
PIRRT 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 PIRRT 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
- PIRRT 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
- Concepcion LA, et al. ARF requiring dialysis: use of shift CVVHD vs. conventional dialysis. J Am Soc Nephrol. 2009;Suppl, F-P01557 (Abstract).
- 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.
- Kraus MA. Selection of Dialysate and Replacement Fluids and Management of Electroyte and Acid-Base Disturbances. Seminars in Dialysis. 2009;22(2):137-140.
Risks and Responsibilities
Renal replacement therapy, as with any medical therapy is not without risks. The decision of which therapy and medical device 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 that one therapy is clinically better than the other.
The use of anticoagulation is at the discretion of the prescribing physician.