Oxygen delivery to the blood stream by the dialysis fluid during continuous renal replacement therapy ex vivo

Abstract

Continuous renal replacement therapy (CRRT) maintains a balance in body water and electrolytes. CRRT supplies a higher quantity of fluid than intravenous fluid therapy along with simultaneous fluid withdrawal. We hypothesized that use of a high-oxygen-containing solution for high-volume fluid exchange would improve oxygenation in the blood during CRRT. To start with, we prepared a solution containing high oxygen. The objective of this study was to determine if this solution would increase the partial pressure of oxygen (pO 2) in the blood more than that using a conventional solution during CRRT. We compared the gas profile of the experimental fluid ex vivo in a simulated CRRT for 24 h, using 2-L batches of bovine blood. A significant increase in the pO 2 , pH, and total oxygen delivery, and a significant decrease in the partial pressure of carbon dioxide (pCO 2) were estimated in the bovine blood using the experimental solution during the simulated CRRT. This method is simpler to apply for oxygenation than the conventional method, and will be beneficial to hypoxic patients in terms of improving their blood oxygenation during CRRT.

Effects of continuous renal replacement therapy on Apache-II score, creatinine, and urea nitrogen levels in patients with acute kidney injury

“…14 In this study, the CRRT was used in the treatment of patients with AKI. Our results showed that the total effective rate and survival rate after six months in the observation group were higher than those in the control Huihui Hou et al 17 In addition, the levels of serum K + , Cland Na + in the observation group after the treatment were also lower than those in the control group (P<0.05), suggesting that the CRRT can also promote the recovery of serum electrolytes and fluid balance in patients with AKI, in agreement with the study of Tangy et al 18 CRRT simulates the process of removing solute and water from the kidney by simulating glomerular filtration. It removes solutes with molecular weight less than 50000 in the form of convection.…”

The use of hollow fibre membrane dialysers in a liquid-liquid configuration for respiratory support

“…In resource-poor environments where ECMO capabilities are not available, it has been proposed to use hollow fibre membrane dialysers for respiratory support as dialysis is a widely used technique, with existing clinical approval and a lower resource cost (Rubin, Stacey, Matambo, Vale, et al, 2020). Dialysers are used for haemodialysis therapy and continuous renal replacement therapy (CRRT) where they replace kidney function by filtering small and medium toxins and managing electrolyte and acid balances in the body (Tange & Yoshitake, 2019;ter Beek et al, 2020).…”

“…The differences are in the membrane type, flow rate, and counter-current flow. HFMD commonly uses a polysulfone membrane that is more permeable than membranes used in ECMO as it is required to exchange not just gas but larger toxins and fluids as well (Tange & Yoshitake, 2019;ter Beek et al, 2020). Dialyser cartridges are also smaller than ECMO resulting in a lower blood flow which means a single cartridge set-up is not capable of providing full oxygenation of blood (Rubin, Stacey, Matambo, Vale, et al, 2020;Sidebotham et al, 2012).…”

“…Blood oxygenation using HFMD During the application of conventional dialysis, it has been found that the partial pressure of oxygen in the blood passing through the dialyser had increased (Tange & Yoshitake, 2019). Simulated dialysis using bovine blood has also shown that oxygenating the dialysate results in increased levels of blood oxygenation (Tange et al, 2012;Tange & Yoshitake, 2019). However, there is contradictory evidence on the effect of dialysate oxygenation on blood carbon dioxide levels (Tange et al, 2012;Tange & Yoshitake, 2019).…”

“…Simulated dialysis using bovine blood has also shown that oxygenating the dialysate results in increased levels of blood oxygenation (Tange et al, 2012;Tange & Yoshitake, 2019). However, there is contradictory evidence on the effect of dialysate oxygenation on blood carbon dioxide levels (Tange et al, 2012;Tange & Yoshitake, 2019). A combination of membrane lung, hemodiafiltration, and acid addition has been shown to remove carbon dioxide from blood (Takahashi et al, 2018).…”