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Predilution versus postdilution for continuous arteriovenous hemofiltration.

A A Kaplan

    Transactions - American Society for Artificial Internal Organs
    |January 1, 1985
    PubMed
    Summary
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    Continuous venovenous hemofiltration (CVVH) predilution mode significantly increases net urea clearance by 18% compared to postdilution. This mode allows for greater use of suction-assist, enhancing clearance and potentially filter life.

    Area of Science:

    • Nephrology
    • Critical Care Medicine
    • Renal Replacement Therapy

    Background:

    • Continuous venovenous hemofiltration (CVVH) is a vital renal replacement therapy in intensive care.
    • Predilution and postdilution are two primary modes of fluid administration in CVVH.
    • Understanding the comparative efficacy and safety of these modes is crucial for optimizing patient outcomes.

    Purpose of the Study:

    • To compare the predilution mode of CVVH with the postdilution mode.
    • To evaluate the impact of predilution on net urea clearance and the use of suction-assist.
    • To assess the effects of predilution on filter life and replacement fluid costs.

    Main Methods:

    • Comparative analysis of predilution and postdilution modes in CVVH.
    • Measurement of net urea clearance.

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  • Evaluation of hematocrit and protocrit levels with suction-assist.
  • Assessment of replacement fluid volume and associated costs.
  • Analysis of potential impact on filter lifespan.

    • Main Results:

    • Predilution mode demonstrated an 18% increase in net urea clearance compared to postdilution.
    • The combination of predilution and suction-assist achieved a 60% increase in net urea clearance.
    • Predilution may extend effective filter life by diluting prefilter hematocrit and clotting factors.
    • Replacement fluid costs increased modestly (10-30%), but this was offset by potential filter life extension and reduced need for intermittent hemodialysis.

    Conclusions:

    • CVVH predilution mode offers significant advantages in net urea clearance, especially when combined with suction-assist.
    • Predilution can lead to a longer effective filter life and potentially reduce overall therapy costs.
    • While replacement fluid costs are slightly higher, the benefits in urea clearance and reduced need for other therapies outweigh the drawbacks.