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Erschienen in: Pediatric Nephrology 10/2016

30.04.2016 | Original Article

CVVHD treatment with CARPEDIEM: small solute clearance at different blood and dialysate flows with three different surface area filter configurations

verfasst von: Anna Lorenzin, Francesco Garzotto, Alberta Alghisi, Mauro Neri, Dario Galeano, Stefania Aresu, Antonello Pani, Enrico Vidal, Zaccaroa Ricci, Luisa Murer, Stuart L. Goldstein, Claudio Ronco

Erschienen in: Pediatric Nephrology | Ausgabe 10/2016

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Abstract

Background

The CARdiorenal PEDIatric EMergency (CARPEDIEM) machine was originally designed to perform only continuous venovenous hemofiltration (CVVH) in neonatal and pediatric patients. In some cases, adequate convective clearance may not be reached because of a limited blood flow. In such conditions, the application of diffusive clearance [continuous venovenous hemodialysis (CVVHD)] would help optimize blood purification. In this study, the CARPEDIEM™ machine was modified to enable the circulation of dialysis through the filter allowing testing of the performance of CARPEDIEM™ machine in CVVHD.

Methods

Three different polyethersulfone hemodialyzers (surface area = 0.1 m2, 0.2 m2, and 0.35 m2, respectively) were tested in vitro with a scheduled combination of plasma flow rates (Qp = 10-20-30 ml/min) and dialysis fluid flow rate (Qd = 5-10-15 ml/min). Three sessions were performed in co-current and one in counter-current configuration (as control) for each filter size. Clearance was measured from the blood and dialysate sides and results with mass balance error greater than 5 % were discarded.

Results

Urea and creatinine clearances for each plasma/dialysate combination are reported: clearance increase progressively for every filter proportionally to plasma flow rates. Similarly, clearances increase progressively with dialysate flow rates at a given plasma flow. The clearance curve tends to present a steep increase for small increases in plasma flow in the range below 10 ml/min, while the curve tends to plateau for values averaging 30 ml/min. As expected, the plateau is reached earlier with the smaller filter showing the effect of membrane surface-area limitation. At every plasma flow, the effect of dialysate flow increase is evident and well defined, showing that saturation of effluent was not achieved completely in any of the experimental conditions explored. No differences (p > 0.05 for all values) were obtained in experiments using whole blood instead of plasma or using co-current versus counter-current dialysate flow configuration.

Conclusions

Although plasma flow and filter surface give an important contribution to the level of clearance urea and creatinine, it appears evident that dialysate flow plays an essential role in the blood purification process, justifying the use of CVVHD versus CVVH in case of high dialysis dose requirement and/or limited blood flow rate.
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Metadaten
Titel
CVVHD treatment with CARPEDIEM: small solute clearance at different blood and dialysate flows with three different surface area filter configurations
verfasst von
Anna Lorenzin
Francesco Garzotto
Alberta Alghisi
Mauro Neri
Dario Galeano
Stefania Aresu
Antonello Pani
Enrico Vidal
Zaccaroa Ricci
Luisa Murer
Stuart L. Goldstein
Claudio Ronco
Publikationsdatum
30.04.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Pediatric Nephrology / Ausgabe 10/2016
Print ISSN: 0931-041X
Elektronische ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-016-3397-2

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