Platelet Consumption and Filter Clotting Using Two Different Membrane Sizes during Continuous Venovenous Haemodiafiltration in the Intensive Care Unit

Abstract

Background. The aim of this study was to investigate whether different haemofilter surface areas affect clotting and platelet consumption in critically ill patients undergoing continuous venovenous haemodiafiltration (CVVHDF). Methods. CVVHDF was performed in postdilution technique using a capillary haemofilter with two different membrane sizes, Ultraflux AV 1000S (n = 17, surface 1.8 m2, volume 130 mL), and the smaller AV 600S (n = 16, surface 1.4 m2, volume 100 mL), respectively. Anticoagulation was performed with heparin. Results. No significant differences were found when the two filters were compared. CVVHDF was performed for 33 (7–128) hours with the filter AV 1000S and 39 (7–97) hours with AV 600S (P = 0.68). Two (1–4) filters were utilised in both groups over this observation period (P = 0.94). Platelets dropped by 52,000 (0–212,000) in AV 1000S group and by 89,500 (0–258,000) in AV 600S group (P = 0.64). Haemoglobin decreased by 1.2 (0–2.8) g/dL in AV 1000S group and by 1.65 (0–3.9) g/dL in AV 600S group (P = 0.51), leading to the transfusion of 1 (0–4) unit of blood in 19 patients (10 patients with AV 1000S and 9 with AV 600S). Filter observation was abandoned due to death (12.1%), need for systemic anticoagulation (12.1%), repeated clotting (36.4%), and recovery of renal function (39.4%). Conclusion. Our study showed that a larger filter surface area did neither reduce the severity of thrombocytopenia and anaemia, nor decrease the frequency of clotting events.

Non anti-coagulant factors associated with filter life in continuous renal replacement therapy (CRRT): a systematic review and meta-analysis

“…Classically diffusive transport improves with haemofilter membrane area and anecdotally increased membrane area prolongs filter life however a single study comparing membrane area did not demonstrate an advantage [ 45 ].…”

Shock Management for Cardio-surgical Intensive Care Unit Patient: The Silver Days

“…70 62 Anticoagulation is required to prevent membrane clotting and dysfunction. Regional anticoagulation with citrate has the advantage over heparin 75 to reduce the bleeding risk in post-operative patients after cardiac surgery, as heparin anticoagulation can be complicated by platelet-and red blood cell-consumption. 75 However, impaired cellular aerobic metabolism (Krebs cycle) puts the patients at risk for insufficient citrate metabolism and citrate accumulation.…”

Circuit haemodynamics during non-citrate and regional citrate continuous renal replacement, and impact of blood flow on filter life

“…[1][2][3][4][5][6][7] AKF contributors include but are not limited to anticoagulation, [8][9][10] access catheter 1,2,[11][12][13] and treatment configuration factors. 1,5,7,[14][15][16][17] Analysis of minute-to-minute circuit pressures, flow and alarms is possible via digital machine recordings, improving understanding of circuit failure mechanisms during continuous veno-venous hemodiafiltration (CVVHDF) 3,4 and continuous veno-venous haemodialysis (CVVHD). 5 However, prior assessments involved circuits that were not receiving regional citrate anticoagulation (RCA).…”

“…1–7 AKF contributors include but are not limited to anticoagulation, 8–10 access catheter 1,2,11–13 and treatment configuration factors. 1,5,7,14–17…”