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AN-69 membrane reactions are pH-dependent and preventable.
P D Brophy1, T A Mottes, T L Kudelka
1Pediatric Dialysis Program, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA. "pbrophy@umich.edu
Summary
Blood priming for continuous venovenous hemodiafiltration using AN-69 membranes can cause hypotension in pediatric patients. Techniques are presented to ensure safer use of these AN-69 membranes.
Area of Science:
- Nephrology
- Pediatric Critical Care
- Biomaterials Science
Background:
- Continuous venovenous hemodiafiltration (CVVHDF) is a vital renal replacement therapy for critically ill pediatric patients.
- Blood priming of CVVHDF circuits, particularly with the AN-69 membrane, has been associated with adverse events.
Observation:
- Two pediatric patients experienced significant hypotensive episodes during CVVHDF initiation when blood-primed with the AN-69 dialyzer membrane.
- Hypotension resolved immediately upon discontinuation of CVVHDF.
- No similar hypotensive events occurred when patients were primed with saline or albumin.
Findings:
- The AN-69 membrane is highly sensitive to pH, potentially activating bradykinin (a hypotensive agent) with acidic blood (pH 6.1-6.4) used for priming.
- Blood bank blood exhibited acidic pH, hyperkalemia, hyponatremia, and hypocalcemia, unlike neutral pH saline.
- Endogenous blood substances, like bradykinin, are speculated to induce hypotension during blood priming.
Implications:
- Developed techniques aim to improve the safe and effective utilization of AN-69 membranes in pediatric CVVHDF circuits.
- Highlights the critical need for meticulous attention to detail in renal replacement therapy for pediatric patients, especially those under 10 kg.
- Suggests careful consideration of blood product characteristics and dialyzer membrane interactions in CVVHDF management.