Solute clearances during continuous venovenous haemofiltration at various ultrafiltration flow rates using Multiflow-100 and HF1000 filters
Solute clearances during continuous venovenous haemofiltration at various ultrafiltration flow rates using Multiflow-100 and HF1000 filters
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DOI：
10.1093/ndt/gfg055
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发表时间：
2003-05-01
影响因子：
6.1
通讯作者：
Leblanc, M
中科院分区：
文献类型：
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作者：
Troyanov, S;Cardinal, J;Leblanc, M
背景在连续性静脉-静脉血液滤过（CVVH）中，高超滤率可为急性肾衰竭患者提供生存获益。本研究测量了在超滤速率高达4.5 l/h时获得的清除率。CVVH期间测量了小溶质（尿素、肌酐、磷酸盐和尿酸盐）和β 2-微球蛋白（β 2-M）的清除率。比较了五个预设的Multiflow-100（M-100）和五个HF 1000中空纤维过滤器。对于M-100，将通过血液滤过获得的清除率与通过血液透析滤过获得的清除率进行比较，两者在既往研究中的总流出率相似。对于小分子溶质，在所有超滤速率下，流出液与血浆之比（E/P）保持接近1.0;因此，两种过滤器的过滤器清除率均等于Quf。将Quf从1.0升/小时增加到4.5升/小时并没有显著改变E/P。β（2）-M的对流清除率低于小溶质的对流清除率。对于M-100，平均β（2）-ME/P为0.62+/-0.10，并且在增加Quf时没有显著变化。对于HF 1000，平均β（2）-ME/P显著低于M-100（1.0 l/h时为0.42+/-0.09），当Quf增加至4.5 l/h时，平均β（2）-ME/P逐渐降低至0.26+/-0.06。在前稀释的情况下，观察到输送至患者的清除率逐渐降低，在Quf速率为4.5 l/h时达到40%。β（2）-M无临床显著吸附。对于M-100，在相似的总流出液流速下，与仅血液滤过相比，使用血液透析滤过输送给患者的小分子溶质清除率显著较高，但β 2-M清除率较低。在评价速率下，小溶质的过滤器清除率等于Quf。在高超滤速率下，前稀释的清除率显著降低。在使用前稀释的相似总流出率下，血液透析滤过。小溶质清除率上级血液滤过，但β（2）-M低于血液滤过。
Background. In continuous venovenous haemofiltration (CVVH), high ultrafiltration rates provide survival benefits in acute renal failure. This study measured clearances obtained at ultrafiltration rates of up to 4.5 l/h.Methods. Clearances of small solutes (urea, creatinine, phosphate and urate) and Of beta(2)-microglobulin (beta(2)-M) were measured during CVVH. Five preset Multiflow-100 (M-100) and five HF1000 hollow-fibre filters were compared. For the M-100, clearances obtained by haemofiltration were compared with those obtained by haemodiafiltration at similar total effluent rates from a previous study.Results. For small solutes, the effluent to plasma ratio (E/P) remained close to 1.0 at all ultrafiltration rates; filter clearances were thus equal to Quf for both filters. Increasing Quf from 1.0 to 4.5 l/h did not significantly modify E/P. Convective clearances Of beta(2)-M were lower than those obtained for small solutes. For the M-100, average beta(2)-M E/P was 0.62+/-0.10 and did not significantly change while increasing Quf. For the HF1000, average beta(2)-M E/P were significantly lower compared with the M-100 (0.42+/-0.09 at 1.0 l/h) and decreased progressively to 0.26+/-0.06 while increasing Quf to 4.5 l/h. With pre-dilution, progressive decreases in clearances delivered to patients were observed reaching 40% at a Quf rate of 4.5 l/h. There was no clinically significant adsorption Of beta(2)-M. For the M-100, at similar total effluent flow rates, clearances delivered to patients using haemodiafiltration were significantly higher for small solutes but lower for beta(2)-M in comparison to haemofiltration only.Conclusions. Filter clearance for small solutes equalled Quf at evaluated rates. At high ultrafiltration rates there was significant loss of clearances with pre-dilution. At similar total effluent rates with the use of pre-dilution, haemodiafiltration is. superior to haemofiltration for small solute clearance but inferior for beta(2)-M.