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Continuous hemofiltration and platelet function in critically ill patients

J Boldt1, T Menges, M Wollbrück

  • 1Department of Anesthesiology and Intensive Care Medicine, Justus-Liebig-University Giessen, FRG.

Critical Care Medicine
|July 1, 1994
PubMed
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Continuous veno-venous hemofiltration significantly impairs platelet function, with substantial reductions in aggregation observed within days. This platelet dysfunction is linked to a 100% mortality rate when aggregation decreases by over 60%.

Area of Science:

  • Nephrology
  • Critical Care Medicine
  • Hematology

Background:

  • Acute renal failure (ARF) in critically ill patients often requires renal replacement therapy.
  • Continuous veno-venous hemofiltration (CVVH) is a common treatment for ARF in intensive care units.
  • The impact of CVVH on platelet function in these patients is not fully understood.

Purpose of the Study:

  • To evaluate the effect of continuous pump-driven veno-venous hemofiltration on platelet function.
  • To assess changes in platelet aggregability during CVVH therapy.

Main Methods:

  • Prospective study in a surgical intensive care unit.
  • Twenty critically ill patients with ARF undergoing CVVH were compared to 20 controls without ARF.
  • Platelet function was measured using turbidimetric aggregometry with adenosine diphosphate, collagen, and epinephrine as inductors, before and during the first 5 days of CVVH.

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Main Results:

  • CVVH significantly reduced maximum platelet aggregation and the maximum gradient of aggregation in response to all inductors.
  • Reductions in platelet aggregation reached 62-86% for maximum aggregation and 40-88% for maximum gradient compared to baseline.
  • A decrease in platelet aggregation variables greater than 60% was associated with 100% mortality.

Conclusions:

  • Continuous pump-driven veno-venous hemofiltration significantly impairs platelet aggregability.
  • The changes in platelet function become evident 2 to 3 days after initiating hemofiltration.
  • Severe platelet dysfunction during CVVH may be a marker of poor prognosis.