Clinical aspects and applications of hemofiltration

Area of Science:

• Nephrology
• Critical Care Medicine
• Pharmacokinetics

Background:

• Hemofiltration (HF) and continuous arteriovenous hemofiltration (CAVH) are renal replacement therapies.
• Hemodialysis (HD) is a common treatment for renal failure.
• Long-term effects and specific applications of HF and CAVH require further investigation.

Purpose of the Study:

• To evaluate the long-term effects of intermittent hemofiltration (HF).
• To assess the efficacy and outcomes of continuous arteriovenous hemofiltration (CAVH) in critically ill patients with acute renal failure.
• To investigate the pharmacokinetics of cefuroxime and the removal of aluminum and parathyroid hormone (PTH) during hemofiltration.

Main Methods:

• Follow-up of 30 patients undergoing intermittent hemofiltration (HF).
• Treatment of 100 critically ill patients with acute renal failure using continuous arteriovenous hemofiltration (CAVH).
• Pharmacokinetic studies of cefuroxime, aluminum clearance, and PTH levels during HF and CAVH.

Main Results:

• HF showed comparable biochemical and uremic control to HD, with patient preference for HF due to fewer complications.
• CAVH achieved a 45% survival rate in critically ill patients, enabling nutritional support without overhydration.
• HF demonstrated higher cefuroxime removal than HD, and CAVH accounted for two-thirds of total cefuroxime clearance.
• HF significantly increased aluminum clearance and reduced PTH and osteocalcin levels compared to HD.
• Significant amounts of PTH were found in the ultrafiltrate during HF, with potential down-regulation of PTH secretion.

Conclusions:

• Intermittent hemofiltration (HF) is a well-tolerated alternative to hemodialysis (HD) with fewer complications.
• Continuous arteriovenous hemofiltration (CAVH) is effective in managing acute renal failure, improving survival and nutritional support in critically ill patients.
• Hemofiltration enhances the clearance of certain drugs and substances like cefuroxime and aluminum, and influences hormone levels (PTH, osteocalcin).
• Dosage adjustments for cefuroxime and considerations for aluminum and PTH management are necessary during HF and CAVH.