Super High‐Flux Continuous Venovenous Hemodialysis Using Regional Citrate Anticoagulation: Long‐Term Stability of Middle Molecule Clearance

Abstract

Continuous renal replacement therapy is a standard treatment in critically ill patients with acute kidney injury. All CRRT techniques provide a high low-molecular weight clearance but even with hemofiltration, clearance of middle molecules is low. We investigated whether a new super high-flux hemofilter provides effective and sustained middle molecule clearance during citrate-anticoagulated continuous venovenous hemodialysis for up to 72 h. We included 14 critically ill patients with AKI-KDIGO-III in a prospective observational trial. We measured/calculated blood and urine concentrations, clearances and sieving coefficients of eight molecules with molecular weights from 60 to 66 kDa, hemodynamic parameters and SAPS-II scores. All filters were patent at 72 h. Clearance and sieving coefficients of small solutes were high and sustained over time, those for larger solutes decreased over 72 h but remained high enough to decrease blood concentrations of solutes up to 25 kDa. Albumin serum levels remained unaffected. Catecholamine doses and SAPS-II scores decreased significantly. This new hemofilter may improve blood purification in critically ill patients with AKI.

Myoglobin clearance with continuous veno-venous hemodialysis using high cutoff dialyzer versus continuous veno-venous hemodiafiltration using high-flux dialyzer: a prospective randomized controlled trial

“…Better clearance of β 2 -microglobulin in the intervention arm in this study is in line with the results of others [17,28,41]. Contrary to these findings, another small cohort (n = 10), which compared the β 2 -microglobulin clearance between CVVHDF using high-flux and HCO dialyzers, showed no difference in both study arms, although the dialysis dose was much higher in the CVVHDF arm (36 ± 4 ml/kg/h) than in the CVVHD arm (21 ± 6 ml/ kg/h) [29].…”

“…A good clearance of β 2 -microglobulin was demonstrated in chronic dialysis patients using dialyzers with increased pore size [26,27]. Recent studies have also confirmed a good clearance for middle molecules in CVVHD with RCA and HCO dialyzers in critically ill patients [17,28].…”

“…In contrast to recent clinical trials which evaluated the clearance of β 2 -microglobulin with HCO membranes [17,[26][27][28][29], we investigated myoglobin as primary endpoint. High myoglobin levels are associated with AKI and higher mortality rates [6,7].…”

Continuous hemodiafiltration as a rescue therapy for patients with cardiopulmonary failure caused by enterovirus-71: a retrospective observational study in a PICU

“…Inconsistently, the ultrafiltrate from patients with heart failureproduced a positive inotropic response potentially attributable to catecholamines [26]. Furthermore, Siebeck M et al [27] indicated that the catecholamine concentration was significantly decreased after continuous hemofiltration. Given that adrenalin (molecular weight: 219) and dopamine (molecular weight: 153) are “small” molecules, we speculated that adrenalin and dopamine may be removed directly by CVVHDF.…”

Filter life span in postoperative cardiovascular surgery patients requiring continuous renal replacement therapy, using a postdilution regional citrate anticoagulation continuous hemofiltration circuit

“…Regional Citrate Anticoagulation (RCA) is the Kidney Disease-Improving Global Outcome (KDIGO) recommended anticoagulation of choice for continuous renal replacement therapy and is of particular value to patients with contraindications to heparin and high risk of bleeding such as those who have undergone cardiac surgery [3,4]. RCA is also associated with a prolonged filter life-span due to a decreased incidence of clotting and preservation of the filter sieving coefficient for larger molecules including inflammatory mediators [5,6]. This anticoagulation modality was reported to be safe and preferred after cardiac surgery [7].…”