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Plasma kinetics of small molecules during and after hemofiltration: decrease in hemofiltration efficiency related to

T Haas, G Dongradi, F Villeboeuf

Clinical Nephrology

|April 1, 1983

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Higher ultrafiltration rates in hemofiltration sessions reduce effective clearance due to delayed mass transfer. This impacts urea and uric acid removal, with greater rebound effects for creatinine and phosphorus.

Area of Science:

Nephrology
Biomedical Engineering
Clinical Medicine

Background:

Hemofiltration (HF) is a renal replacement therapy.
Assessing the real efficiency of HF is crucial for patient outcomes.
Mass transfer delays can impact solute removal during HF.

Purpose of the Study:

To investigate the influence of delayed mass transfer on hemofiltration efficiency.
To compare effective clearance (KE) with plasma clearance (KP) at different ultrafiltration (UF) rates.
To analyze the rebound phenomenon of small molecules post-HF.

Main Methods:

Studied 7 patients undergoing HF at moderate (100 ml/min) and high (200 ml/min) UF rates.
Calculated KE/KP using small molecule kinetics during and after HF.

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Monitored plasma levels of urea, uric acid, creatinine, and phosphorus.

Main Results:

Increasing UF rate from 100 to 200 ml/min decreased KE/KP by 4% for urea and 11% for uric acid.
Plasma levels of creatinine and phosphorus did not stabilize by 90 min post-HF.
A greater rebound phenomenon was observed for creatinine and phosphorus compared to uric acid.

Conclusions:

Higher UF rates in HF can decrease effective clearance due to mass transfer delays.
Delayed diffusion from intracellular bound forms may explain the rebound of creatinine and phosphorus.
Understanding these kinetics is vital for optimizing HF therapy and solute removal.