Revisiting Filtration Fraction as an Index of the Risk of Hemofilter Clotting in Continuous Venovenous Hemofiltration

Hatamizadeh, Parta; Tolwani, Ashita J.; Palevsky, Paul M.

doi:10.2215/cjn.02410220

Cited by 14 publications

(26 citation statements)

References 10 publications

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“…Both modalities are attractive options since they promote higher clearance of middle molecules such as myoglobin than hemodialysis (CVVHD) with a high-flux membrane. 62,63 The drawback of convective modalities is related to elevated filtration fraction 64 and elevated transmembrane pressure 65 that are inherent to these strategies of blood purification and are associated with a reduction in filter life span. 62,66 The HCO membrane is utilized only for CVVHD 67,68 and to date, no sets with MCO filters for CRRT are commercially available.…”

Section: Med I Um and Hi G H Cut-off Memb R Ane Smentioning

confidence: 99%

“…32 Increments in the diffusive clearance do not compromise filter life span as filtration fraction remains unaltered. 63,64 Attention must be paid to correct antibiotic dosing 80,81 according to effluent flow and also to calcium replacement since calcium removal is linearly proportional to effluent flow 82 and high CRRT dose regimens demand higher calcium compensation.…”

Section: S Ing Le-pa Ss Albumin Dialys Ismentioning

confidence: 99%

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Continuous renal replacement therapy and extended indications

Ronco

Reis

2021

Seminars in Dialysis

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Initially developed to replace kidney function in severely ill newborns/infants, and then diverted to severely ill adult patients, 1 continuous renal replacement therapy (CRRT) is now applied to support different organs apart from the kidney in a myriad of clinical conditions such as sepsis, 2 acute liver failure (ALF), 3 acute respiratory distress syndrome (ARDS), 4-6 and cardiogenic shock. 7 The extended indications for CRRT and the concept of sequential extracorporeal therapies 8 are intrinsically related. The individualization of care and selection of treatment candidates based on clinical and molecular phenotypes increases the probability of benefit for each of the proposed blood purification techniques 9-15 (Figure 1).In sepsis, the removal of damage-associated molecular patterns (e.g. cytokines) and pathogen-associated molecular patterns (e.g. endotoxins) might reduce the burden of the disease. 16 In liver failure, CRRT reduces the risk of ammonia-related neurotoxicity while artificial liver support systems effectively reduce bilirubin and bile acids concentrations. 3 In ARDS, extracorporeal CO 2 removal (ECCO 2 R) allows the application of ultra-protective ventilation avoiding deleterious consequences of hypercapnia and reducing the risk of ventilator-associated lung injury. [17][18][19] In cardiogenic shock and cardiac surgery in which shifts in fluid balance are poorly tolerated, CRRT might mitigate further myocardial damage. 20,21

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Section: Med I Um and Hi G H Cut-off Memb R Ane Smentioning

confidence: 99%

Section: S Ing Le-pa Ss Albumin Dialys Ismentioning

confidence: 99%

Continuous renal replacement therapy and extended indications

Ronco

Reis

2021

Seminars in Dialysis

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“…Therefore, a low BFR (<100 mL/min) could increase the risk of clotting due to stasis of blood (high FF). In contrast, a high BFR (>250 mL/min) decreases FF but could affect circuit lifespan due to vascular access issues [23]. The use of pre-filter replacement fluid helps to maintain a lower FF by diluting the blood entering the hemofilter but to the expense of a decrease in solute clearance.…”

Section: Practical Considerations To Determine Crrt Dosementioning

confidence: 99%

Dose of Continuous Renal Replacement Therapy in Critically Ill Patients: A Bona Fide Quality Indicator

Vásquez-Jiménez

Anumudu

Neyra

2021

Nephron

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Acute kidney injury (AKI) is common in critically ill patients, and renal replacement therapy (RRT) constitutes an important aspect of acute management during critical illness. Continuous RRT (CRRT) is frequently utilized in intensive care unit settings, particularly in patients with severe AKI, fluid overload, and hemodynamic instability. The main goal of CRRT is to timely optimize solute control, acid-base, and volume status. Total effluent dose of CRRT is a deliverable that depends on multiple factors and therefore should be systematically monitored (prescribed vs. delivered) and iteratively adjusted in a sustainable mode. In this manuscript, we review current evidence of CRRT dosing and provide recommendations for its implementation as a quality indicator of CRRT delivery.

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“…The ratio of ultrafiltration rate to plasma flow rate within the hemofilter when replacement fluid is infused postfilter is known as the filtration fraction and quantifies the degree of hemoconcentration occurring within the hemofilter. 53 When the filtration fraction is >30%, there is an increased risk for hemofilter failure. Thus, the prescription should be adjusted during hemofiltration to maintain the filtration fraction at <20%.…”

Section: Ckrt Prescriptionmentioning

confidence: 99%

Prescribing Continuous Kidney Replacement Therapy in Acute Kidney Injury: A Narrative Review

Verma

Palevsky

2021

Kidney Medicine

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Revisiting Filtration Fraction as an Index of the Risk of Hemofilter Clotting in Continuous Venovenous Hemofiltration

Cited by 14 publications

References 10 publications

Continuous renal replacement therapy and extended indications

Continuous renal replacement therapy and extended indications

Dose of Continuous Renal Replacement Therapy in Critically Ill Patients: A Bona Fide Quality Indicator

Prescribing Continuous Kidney Replacement Therapy in Acute Kidney Injury: A Narrative Review

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