Chadha V, Garg U, Warady B A, Alon U S
Section of Pediatric Nephrology, The Children's Mercy Hospital, University of Missouri, Kansas City 64108, USA.
Pediatr Nephrol. 2000 Nov;15(1-2):33-5. doi: 10.1007/s004670000450.
Hemodiafiltration has assumed an important role in the supportive therapy of critically ill patients. The viability of the filter used for hemodiafiltration can be monitored by estimating the sieving coefficient of small molecules such as creatinine and/or urea. We report on three patients with severe hyperbilirubinemia whose creatinine sieving coefficient was spuriously elevated as a result of discordance in the accuracy of creatinine measurement in plasma and ultrafiltrate respectively. This discordance was a consequence of lack of bilirubin clearance during hemodiafiltration. As a result, while the plasma creatinine determination by the kinetic Jaffe method was negatively influenced by the hyperbilirubinemia, the ultrafiltrate creatinine was not. This report is the first to document the lack of bilirubin clearance during hemodiafiltration and its impact on the calculation of sieving coefficient based on creatinine. The use of urea as the solute for determining the sieving coefficient allows for an accurate estimate and provides a valid means of monitoring this parameter in the setting of hyperbilirubinemia.
血液滤过在重症患者的支持治疗中发挥了重要作用。用于血液滤过的滤器的活力可通过估算肌酐和/或尿素等小分子的筛系数来监测。我们报告了3例严重高胆红素血症患者，由于血浆和超滤液中肌酐测量准确性不一致，其肌酐筛系数出现假性升高。这种不一致是血液滤过期间胆红素清除不足的结果。因此，虽然动力学Jaffe法测定的血浆肌酐受到高胆红素血症的负面影响，但超滤液中的肌酐不受影响。本报告首次记录了血液滤过期间胆红素清除不足及其对基于肌酐的筛系数计算的影响。使用尿素作为测定筛系数的溶质可进行准确估算，并为高胆红素血症情况下监测该参数提供了有效手段。
