Diffusive and convective solute clearances during continuous renal replacement therapy at various dialysate and ultrafiltration flow rates

Brunet, Sylvain; Leblanc, Martine; Geadah, David; Parent, Daniel; Courteau, Sylvie; Cardinal, Jean

doi:10.1016/s0272-6386(99)70076-4

Cited by 202 publications

(160 citation statements)

References 12 publications

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“…It also reduced variation associated with different anticoagulation strategies. Finally, we have taken into account the effect of predilution, which can reduce urea clearance as much as 15% (32). We have calculated and corrected the delivered dose for this effect (14,30,33).…”

Section: Discussionmentioning

confidence: 99%

Effluent Volume in Continuous Renal Replacement Therapy Overestimates the Delivered Dose of Dialysis

Granado¹,

Macedo²,

Chertow³

et al. 2011

Clinical Journal of the American Society of Nephrology

101

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SummaryBackground and objectives Studies examining dose of continuous renal replacement therapy (CRRT) and outcomes have yielded conflicting results. Most studies considered the prescribed dose as the effluent rate represented by ml/kg per hour and reported this volume as a surrogate of solute removal. Because filter fouling can reduce the efficacy of solute clearance, the actual delivered dose may be substantially lower than the observed effluent rate.Design, setting, participants, & measurements Data were examined from 52 critically ill patients with acute kidney injury (AKI) requiring dialysis. All patients were treated with predilution continuous venovenous hemodiafiltration (CVVHDF) and regional citrate anticoagulation. Filter performance was monitored during the entire course of therapy by measuring blood urea nitrogen (BUN) and dialysis fluid urea nitrogen (FUN) at initiation and every 12 hours. Filter efficacy was assessed by calculating FUN/BUN ratios every 12 hours of filter use. Prescribed urea clearance (K, ml/min) was determined from the effluent rate. Actual delivered urea clearance was determined using dialysis-side measurements.Results Median daily treatment time was 1413 minutes (1260 to 1440) with a total effluent volume of 46.4 Ϯ 17.4 L and urea mass removal of 13.0 Ϯ 7.6 mg/min. Prescribed clearance overestimated the actual delivered clearance by 23.8%. This gap between prescribed and delivered clearance was related to the decrease in filter function assessed by the FUN/BUN ratio.Conclusions Effluent volume significantly overestimates delivered dose of small solutes in CRRT. To assess adequacy of CRRT, solute clearance should be measured rather than estimated by the effluent volume.

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Section: Discussionmentioning

confidence: 99%

Effluent Volume in Continuous Renal Replacement Therapy Overestimates the Delivered Dose of Dialysis

Granado¹,

Macedo²,

Chertow³

et al. 2011

Clinical Journal of the American Society of Nephrology

101

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“…Hemofiltration is achieved by convective clearance, in which solutes are transported along with movement of solvent in response to positive transmembrane pressure. Studies comparing convective and diffusive clearance have shown that middle molecular weight substances and large molecules are better removed by convection (114). Although most inflammatory mediator molecules fall in the middle molecular weight category, they have very high generation rates relative to uremic toxins; therefore, traditional effluent flow rates of 1 to 2 L/h have very little effect.…”

Section: Different Purification Technologies and Their Evaluation In mentioning

confidence: 99%

Potential Interventions in Sepsis-Related Acute Kidney Injury

Ronco¹,

Kellum²,

Bellomo³

et al. 2008

Clinical Journal of the American Society of Nephrology

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Sepsis is an important cause of morbidity and mortality. Acute kidney injury often complicates sepsis, leading to greater complexity, cost of care, and worsening prognosis. In recent years, a consensus definition of acute kidney injury has been developed, facilitating research into the pathophysiology and epidemiology of this disorder. New and emerging biomarkers to recognize kidney injury before functional abnormalities are manifest may allow early recognition and facilitate prevention or treatment. Furthermore, advances in the clinical management of sepsis may have secondary benefits with respect to renal outcomes. Existing and hybrid extracorporeal therapies are being investigated not only as means to replace lost kidney function but also to modulate the immune response to sepsis. For those who have more advanced forms of kidney injury, strategies to promote renal recovery are being sought to minimize the long-term consequences of impaired kidney function. This review provides an update on the current state of the science and a glimpse toward the future of intervention in sepsis-related acute kidney injury.

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“…Other physical factors interfere with the passage of these solutes, making efficacy based only on molecular size unpredictable. Other variables that interfere with transport are: spacial conformation of the molecule, electrical charge, hydrophilia and hydrophobia, ligation to acute phase reactive proteins, and ligation to receptors [13,14]. Current evidence suggests that the most promising option for cytokine clearance is through the mechanism of adsorption in certain types of membrane (polyacrylonitrile, polymethylmethacrylate) during ultrafiltration, along with convective transport of other molecules that have not been detected in ultrafiltration [9].…”

Section: Tnf-á Values Over Timementioning

confidence: 99%

The use of ultrafiltration for inflammatory mediators removal during cardiopulmonary bypass in coronary artery bypass graf surgery

Antunes¹,

Dragosavc²,

Petrucci³

et al. 2008

Rev Bras Cir Cardiovasc

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Diffusive and convective solute clearances during continuous renal replacement therapy at various dialysate and ultrafiltration flow rates

Cited by 202 publications

References 12 publications

Effluent Volume in Continuous Renal Replacement Therapy Overestimates the Delivered Dose of Dialysis

Effluent Volume in Continuous Renal Replacement Therapy Overestimates the Delivered Dose of Dialysis

Potential Interventions in Sepsis-Related Acute Kidney Injury

The use of ultrafiltration for inflammatory mediators removal during cardiopulmonary bypass in coronary artery bypass graf surgery

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