Solute Transport in Continuous Arteriovenous Hemodiafiltration: A New Mathematical Model Applied to Clinical Data

Vincent, H. H.; Ittersum, Frans J. van; Akcahuseyin, E.; Vos, MC; Duyl, W. A. van; Schalekamp, M. A. D. H.

doi:10.1159/000169957

Cited by 16 publications

(7 citation statements)

References 6 publications

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“…For the model to be used, however, one needs input values of the drug sieving coefficient and of the mass transfer coefficient of diffusion. In previous studies we demonstrated the feasibility of predicting Kd of creatinine on the basis of dialysate flow rale and the mem brane hydraulic permeability, as reflected in the rate of ultrafiltration [1,2,14], The present study yielded two important results. First, we were able to demonstrate that a siev ing coefficient of a drug may be equated to its non-protein-bound fraction.…”

Section: Discussionmentioning

confidence: 52%

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Drug Clearance by Continuous Haemodiafiltration

Vincent¹,

Vos²,

Akcahuseyin

et al. 1993

Blood Purif

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In patients who were treated with continuous arteriovenous haemodiafiltration (CAVHD), using the AN-69 capillary dialyser, we measured the clearance rates of uraemic solutes and drugs at dialysate flow rates of 0, 1 and 3 1/h. By using a mathematical model of CAVHD, we analysed the data in terms of sieving coefficients and diffusive mass transfer coefficients. These parameters proved to be related to drug protein binding and molecular weight. The parameter values may be used to calculate the expected drug clearance rate under different operating conditions.

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Section: Discussionmentioning

confidence: 52%

“…With CAVHD, solute transport occurs by both con vection and diffusion. Time-averaged clear ance rates may be severalfold higher than with either CAVH or conventional dialysis tech niques [1,2], Drug clearance rates may be high enough to warrant dosage adjustments.…”

mentioning

confidence: 99%

Drug Clearance by Continuous Haemodiafiltration

Vincent¹,

Vos²,

Akcahuseyin

et al. 1993

Blood Purif

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“…Optimal drug dosing is thus essential in this situation but pharmacokinetic data during continuous renal replacement therapy are scarce. Complex mathematical models have been proposed [2,3], but their application in clinical practice is limited. The current methods to estimate drug removal through the haemofilter rely on sieving coefficients, i.e.…”

Section: Introductionmentioning

confidence: 99%

“…The current methods to estimate drug removal through the haemofilter rely on sieving coefficients, i.e. average filtrate to blood concentration ratios [2][3][4][5]. These values, however, must be determined previously for each drug.…”

Section: Introductionmentioning

confidence: 99%

Pharmacokinetics of antimicrobial agents in anuric patients during continuous venovenous haemofiltration

Joos

Schmidli

Keusch

1996

Nephrology Dialysis Transplantation

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Background. The optimal drug dosing in anuric patients undergoing continuous haemofiltration is a difficult task. More pharmacokinetic data is needed to derive practical guidelines for dosage adjustments. Methods. Drug elimination of various antimicrobial agents (amikacin, amoxycillin, ceftazidime, ciprofloxacin, flucloxacillin, imipenem, netilmicin, penicillin G, piperacillin, sulphamethoxazole, tobramycin, vancomycin) was studied in 24 patients with acute renal failure treated by pump-assisted continuous venovenous haemofiltration (CVVH). Concentrations of serial blood and ultrafiltrate samples were determined by HPLC or by fluorescence polarization immunoassay. Total body clearance (CL) and haemofilter clearance (CL f ) rates were determined by standard modelindependent equations. Data from published literature on fractions not bound to proteins (f u ), non-renal drug clearance fractions (Q o ), and normal clearance values (CL n ) were used to derive a pharmacokinetic model, taking into account drug removal by ultrafiltration and by non-renal clearance. Results. A total of 37 treatment periods was studied. Blood flow through the haemofilters was lOOml/min resulting in an average ultrafiltrate flow rate (UFR) of 13.2 + 4.6 (range 3.2-22.1) ml/min. Acceptable correlations of calculated and measured haemofilter clearances and total body clearances were obtained. Conclusions. Total body clearance in anuric patients during CVVH is predictable from drug properties, which are generally known. The individual dosage requirements may be calculated by multiplying Qo + f u ' UFR/CL n with the dose considered appropriate in the absence of renal impairment.

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“…Over the last years, a variety of synthetic membranes, both in hollow-fiber and parallel-plate configurations, have become available for use in CRRT. However, data on filter efficiency in arteriovenous modalities, CAVHD or CAVHDF, are mostly derived from AN69HF parallelplate [1,11] and hollow-fiber hemofilters [12,13]. More findings regarding diffusive efficiency of membranes of different characteristics are available in continuous venovenous hemodialysis (CVVHD) [14,15].…”

Section: Introductionmentioning

confidence: 99%

Efficiency of Different Hollow-Fiber Hemofilters in Continuous Arteriovenous Hemodiafiltration

et al. 2000

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Low dialysate to blood flow rate ratios are a unique characteristic of continuous arteriovenous hemodiafiltration (CAVHDF) that should allow complete saturation of dialysis fluid with small-molecular-weight blood solutes. The aim of the investigation was to evaluate the performance of different hemofilters in CAVHDF. In 10 critically ill patients with acute renal failure, the efficiency of four hollow-fiber hemofilters, polyamide 0.6 m², polyacrylonitrile (PAN) 0.3 and 0.6 m², acrylonitrile sodium methallylsulfonate (AN69HF) 0.6 m², has been evaluated. For comparison, dialysate flow rates (Q_di) were standardized to 16.6 and 25 ml/min. Samples for urea nitrogen were obtained from the arterial blood line (C_bi) and from the dialysate exit port (C_do) within 24-hour running time. Outflowing dialysate (Q_do) was also measured at the same time. Blood flow (Q_b) was calculated by the bubble transit time technique. Diffusive and total urea clearances were determined. AN69HF and PAN hemofilters provided higher clearances than the polyamide hemofilter. Despite the smaller surface area, PAN 0.3 m² had a total urea clearance comparable to that of PAN 0.6 m² and AN69HF at Q_di = 16.6 ml/min. While at Q_di = 16.6 ml/min equilibrium between blood and dialysate (C_do/C_bi ≅ 1) occurred with the AN69HF and PAN hemofilters, at Q_di = 25 ml/min the equilibrium was obtained only with the AN69HF hemofilter. In conclusion, almost complete urea saturation of dialysis fluid has not been obtained with all hemofilters tested here. In our experience, membrane characteristics play an important role in determining diffusive efficiency in CAVHDF.

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Solute Transport in Continuous Arteriovenous Hemodiafiltration: A New Mathematical Model Applied to Clinical Data

Cited by 16 publications

References 6 publications

Drug Clearance by Continuous Haemodiafiltration

Drug Clearance by Continuous Haemodiafiltration

Pharmacokinetics of antimicrobial agents in anuric patients during continuous venovenous haemofiltration

Efficiency of Different Hollow-Fiber Hemofilters in Continuous Arteriovenous Hemodiafiltration

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