Albumin Loss and Citrate Load in Pre-Dilution High Cut-Off-CVVHDF with Regional Citrate (18 mmol/L) and High Cut-Off CVVHD with Systemic Heparin: An in vitro Study

Abstract

Background: Convective therapies with high cut-off membranes (HCO) are usually not recommended because of theoretical excessive albumin loss. The aim of this in vitro study is to demonstrate the noninferior safety of pre-dilution hemodiafiltration with HCO (HCO-CVVHDF) with isotonic citrate anticoagulation (18 mmol/L) with respect to heparin anticoagulated hemodialysis with HCO (HCO-CVVHD) in terms of albumin removal and citrate load. Method: ­Albumin removal was compared in vitro between 3 pre-­dilution-HCO-CVVHDF with citrate anticoagulation and 3 ­HCO-CVVHD with heparin anticoagulation during 30-min single-pass and 180-min recirculation phases. Results: Considering concentrations and flows in the extracorporeal circuit, the transmembrane albumin removal was 2.06 (1.51; 2.09) g and 2.09 (1.9; 2.8) g respectively for HCO-CVVHDF and HCO-CVVHD, during the single-pass phase; 2.8 (2.67; 4.59) g and 2.54 (2.35; 4.67) g, respectively, for HCO-CVVHDF and HCO-CVVHD during the recirculation phase. Based on the citrate saturation coefficients, a citrate metabolic load of 8.86 mmol/h has been calculated for HCO-CVVHDF. Conclusion: HCO-CVVHDF performed with regional anticoagulation with 18 mmol/L citrate solution does not induce higher ­albumin transmembrane removal compared to HCO-CVVHD.

High cut-off membranes in patients requiring renal replacement therapy: a systematic review and meta-analysis

“…The loss of albumin is the most important adverse reaction to HCO membranes, although compared with HF membranes, HCO membranes have increased the removal of β2-microglobulin, and albumin loss also increases [52,53] . Our meta-analysis also suggested a more significant loss of albumin with the treatment of HCO membranes.…”

“…The loss of albumin is the most important adverse reaction to HCO membranes, although compared with HF membranes, HCO membranes have increased the removal of β2-microglobulin, and albumin loss also increases. [ 52 , 53 ] Our meta-analysis also suggested a more significant loss of albumin with the treatment of HCO membranes. However, based on the results of the subgroup analysis, we found that only the HCO membrane with the material of polyarylethersulfone showed a statistically significant difference in the loss of serum albumin.…”

Sampling from Extracorporeal Circuit: A Step Forward for Dose Monitoring in Continuous Renal Replacement Therapy

“…The excess or deficient mass is described as a percentage of the mass entering the haemodiafilter (prefilter). The accuracy of the sampling process is assessed by the values obtained from the calculation of the percentage error of the mass balance [6,8]:…”

Use of Fluoride as a Marker Solute to Quantify the Current Effective Delivered Dose in Continuous Renal Replacement Therapy: An “in vitro” Study

“…At these time points, urea and fluoride concentrations have been measured pre-filter (in the inflow line), post-filter (in the outflow line) and in the effluent line. The mass balance error, SA or SC and Cl were calculated using equations described in Table 2 [12].…”

“…A mass balance error below 10% was deemed acceptable, while a value below 5% was considered optimal. All inflow, outflow and effluent samples with solute mass balance errors higher than 10% were not considered for further analysis [12].…”